Cervical Myelopathy (Cervical Spondylotic Myelopathy)

What is cervical myelopathy?

Cervical myelopathy is compression of the spinal cord in your neck. It can happen if an injury, tumor or herniated disk puts pressure on that part of your spinal cord.

We all have mornings when we wake up with a stiff neck or neck pain. Cervical myelopathy causes pain that doesn’t go away. It may make your hands feel numb or cause muscle weakness.

A healthcare provider can offer treatment options like surgery to decompress your spinal cord to prevent complications.

What is cervical spondylotic myelopathy?

The most common type of cervical myelopathy is cervical spondylotic myelopathy (degenerative cervical myelopathy). It happens as you get older and your bones, disks and ligaments become thinner or lose flexibility and strength.

Surgery treats this type of cervical myelopathy.

How common is cervical myelopathy?

Cervical spondylotic myelopathy is the most common type of cervical myelopathy. In the United States, 15,000 to 20,000 people visit the hospital each year with symptoms of cervical spondylotic myelopathy.

What are the symptoms of cervical myelopathy?

The symptoms of cervical myelopathy and cervical spondylotic myelopathy include:

• Neck pain or stiffness.
• Numbness or tingling in your hands and arms.
• Muscle weakness in your hands and arms.
• Loss of balance and difficulty walking.
• Difficulty with fine motor skills (like buttoning a shirt or holding silverware).

Why does cervical myelopathy affect the legs?

Your spinal cord supports nerves that send signals throughout your entire body. And your nerves work in a connected network throughout your body. That’s why compression in your neck may affect the signals sent by nerves in the lower part of your spinal cord that control your legs.

What causes cervical myelopathy?

Compression or pressure against the spinal cord in your neck region causes cervical myelopathy. Common causes of compression include:

• Bone spurs.
• Herniated disk.
• Narrow cervical canal (birth defect).
• Rheumatoid arthritis.
• Spondylolisthesis.
• Spinal degeneration.
• Spinal stenosis.
• Traumatic injury.
• Tumor.

Cervical spondylotic myelopathy happens due to age-related changes that affect the structure and function of parts of your spine in your neck (spinal degeneration). These changes narrow the spinal canal (the opening where your spinal cord sits), which puts pressure on your spinal cord. Degenerative changes are a natural part of getting older.

What are the risk factors for cervical myelopathy?

Cervical myelopathy can affect anyone at any age. Studies show it’s more common among people of Asian descent older than 30 years.

Cervical spondylotic myelopathy can affect anyone as well, but it’s more common among men and people assigned male at birth and adults after age 40. The average age of a diagnosis is 64.

What are the complications of cervical myelopathy?

If left untreated, cervical myelopathy symptoms may get worse. This might cause:

• Severe pain.
• Bowel and bladder dysfunction.
• Nerve damage.
• Difficulty walking (instability, high risk of falls).
• Limited use of your fingers, hands and arms.
• Paralysis.

How is cervical myelopathy diagnosed?

A healthcare provider will diagnose cervical myelopathy after a physical exam, a neurological exam and other testing. During the exams, your provider will review your symptoms and medical history. They may also test your balance, reflexes and dexterity, and observe you walking (if possible) to better understand how symptoms affect you.

Your provider may order imaging tests to look at your spine. Imaging tests may include:

• X-ray.
• MRI.
• CT scan.
• Myelogram.

Can cervical myelopathy be cured?

There isn’t a cure available for all causes of cervical myelopathy. Surgery can decrease symptoms and prevent complications. Even after treatment, age-related changes may affect more than one area of your spine.

How is cervical myelopathy treated?

There are two routes of treatment for cervical myelopathy, including:

• Nonsurgical management.
• Surgical treatment.

Your provider will likely start with nonsurgical options before considering surgery, but this could vary based on the severity of symptoms and what’s causing them.

Nonsurgical cervical myelopathy management

A healthcare provider may recommend nonsurgical options to help you manage mild cervical myelopathy. They may include:

• Wearing a neck brace.
• Participating in physical therapy.
• Taking medications.

If you need to take medications, there are different options to help you manage specific symptoms, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Corticosteroids.
• Pain relievers.

Nonsurgical treatment addresses immediate symptoms, but it doesn’t provide long-term relief or open a narrow spinal canal.

Surgical cervical myelopathy treatment

Your healthcare provider may recommend surgery to decompress your spinal cord in severe cases of cervical myelopathy.

You may be a candidate for surgery if you have:

• Severe pain.
• Muscle weakness.
• Numbness.
• Balance and walking challenges.
• Difficulty with fine motor skills.

The procedure that a surgeon recommends can vary based on your symptoms, general health and your age. It may include one or a combination of the following:

• Diskectomy.
• Disk replacement.
• Laminectomy.
• Laminoplasty.
• Spinal fusion.

Your surgeon will explain the possible risks before the procedure so you can make an informed decision about your health.

After surgery, you’ll need to take it easy as you recover. Avoid heavy lifting or strenuous activities until your provider tells you they’re safe. Your surgeon will give you specific instructions on how to take care of yourself and when you should see them for a follow-up visit.

Can cervical myelopathy be prevented?

You can’t prevent all causes of cervical myelopathy. Spinal cord compression related to cervical spondylotic myelopathy happens due to natural changes to your body as you age, which you can’t prevent. But you can reduce your risk of injury by taking safety precautions and avoiding high-risk or dangerous activities.

What’s the outlook for cervical myelopathy?

Your outlook on cervical myelopathy depends on the cause. Mild cases of cervical myelopathy that get better with nonsurgical management usually have a positive outcome after surgical treatment.

Cervical myelopathy can get worse if left untreated. Severe cases may cause permanent, irreversible nerve damage, which can lead to complications like intense pain and difficulty moving.

Let a healthcare provider know right away if you have symptoms of cervical myelopathy. They can help you find treatment options that work best for your life.

How long can a person live with cervical myelopathy?

Mild cases of cervical myelopathy don’t affect your life expectancy, but symptoms can affect your quality of life. Severe cases can lead to permanent nerve damage or complications like paralysis. Each person’s outlook varies based on many factors like general health and age. Your healthcare provider can give you the best information about your situation.

How fast does cervical myelopathy progress?

This varies based on why you have symptoms. For example, it could happen suddenly after an accident or progress slowly as you age. Your healthcare provider will review your symptoms and any imaging tests they order to give you their best prediction on the speed of progression and your risk of developing complications.

When should I see a healthcare provider?

Visit a healthcare provider if you notice symptoms of cervical myelopathy. They may run tests to determine if there’s compression on your spinal cord.

If you have cervical myelopathy, let your provider know if the symptoms you experience get worse or if you notice side effects of treatment.

What questions should I ask my healthcare provider?

• Where in my neck is compression happening?
• What type of treatment do you recommend?
• What are the side effects of treatment?
• Do I need surgery?
• What’s my recovery time after surgery?