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Myelopathy is a pathology of the spinal cord. When the condition occurs due to the trauma, it is known as a spinal cord injury. When this condition is inflammatory, then it is called myelitis. If the disease is vascular in nature, then it is called as vascular myelopathy.
The myelopathy is a spinal cord compression which is one of the common causes of neck or cervical pain. Usually, this condition affects people over 55 years. Approximately 10% of people having the symptoms of spinal stenosis develop myelopathy. This disorder can involve several different medical conditions causing neck pain. The conditions like motor system syndrome, transverse syndrome, partial Brown-Sequard syndrome, transverse syndrome and central cord syndrome.
The pain related with myelopathy is due to the problems in the facet joints of the spine, vertebrae, ligaments, muscles and nerves of your spine.
Cervical Stenosis with Myelopathy:
Our spine may develop degenerative changes in the joints as we age. This can create the tightening of the spinal canal. Over time, this will lead to pinching the spinal cord and compromise the coordination of the extremities. The cervical stenosis is a slow progression condition that pinches the spinal cord in the neck. Cervical myelopathy refers to the compression of the cervical spinal cord due to spinal stenosis. The cervical spinal stenosis with myelopathy is more common in elderly patients.
Some of the causes of myelopathy include normal wear and tear, injury caused by the car accidents, falls and sports. These injuries often affect the ligaments and muscles which stabilize the spine. This can also cause joint dislocations and bone fractures. Myelopathy can also be caused by an inflammatory disease like rheumatoid arthritis that attacks the joints in your spine. Other causes of myelopathy include infections, tumors and congenital abnormalities of the vertebrae present at birth.
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Diagnosis and Treatment of Myelopathy:
The first step to diagnose the myelopathy is a physical exam. The doctor will ask your medical history and specifically check for the problems with your reflexes. This will help him/her determine whether the patient has an overactive or exaggerated reflexes. The doctor will also check for the muscle weakness in your arms, atrophy (a condition in which the muscles deteriorate and shrink in size), numbness in your arms and hands.
Additional diagnostics include x-rays to determine the alignment of the vertebrae in your neck, a myelogram to check for bone spurs and narrowing of your spinal canal, an MRI to look for spinal cord compression. An EMG (electromyogram) is helpful in to exclude other disorders that cause symptoms similar to the myelopathy.
Symptoms and Treatment of Myelopathy:
The most common symptoms of myelopathy include deep aching pain in one or both sides of your neck, shoulders or arms, neck stiffness, weakness in your legs and difficulty with walking. The symptoms also include feeling crackling sensation when you move your neck. Patients with myelopathy commonly experience stabbing pain in their arm, fingers, elbow and wrist, numbness or dull ache in the arm. The symptoms of myelopathy progress gradually over many years and may not be evident until the spinal cord has been compressed by at least 30%.
Treatments of Myelopathy:
The treatments of myelopathy include conservative treatment, epidural steroid injection (ESI) and surgical treatment.
- Conservative treatment: Watchful waiting is appropriate for patients suffering from the mild symptoms of myelopathy. The doctor will recommend a brace to immobilze your cervical spine (neck), manipulation, exercises to improve neck strength and flexibility and pain medication like NSAID (Non-Steroidal Anti-Inflammatory Drug). Some experts recommend against these treatments as they are not helpful and in certain cases can cause neurological complications.
- Epidural Steriod Injection (ESI): This can be used to relieve the muscle strain or sprain and decrease the inflammation. Injections can also help reduce the swelling.
A steroid injection is a combination of the cortisone and a local anesthetic that are injected through your back into the epidural space. This treatment is used only when the conservative treatments have failed. ESI is not always helpful to relieve the symptoms of inflammation.
- Surgical Treatment: The surgery for myelopathy is performed to decompress the spine. The surgeon will choose performing laminotomy using a posterior approach (by creating an incision in your back). During this procedure, he will open up the vertebrae in your spine that may be pressing your spinal cord to give it more room. However, this procedure may not be suitable for all patients because it may lead to development of kyphosis or segmental instability. The doctor may choose an anterior cervical approach (perform the surgery by creating incisions through the front of your neck). This method will allow your doctor to directly see and remove the bone spurs and disc materials that may be pressing the spinal cord. During this surgery, your doctor may also perform a spinal fusion to reduce the risk of complication post surgery.