Myelopathy
Myelopathy is an injury to the spinal cord caused by severe compression. This compression may result from trauma, congenital stenosis, disc herniation, or degenerative disease. Your spinal cord is a group of nerves housed inside your spine running almost its entire length. If any portion of the spinal cord gets compressed or constricted, the resulting symptoms are termed myelopathy.
Types
Depending on where the condition is on the spine, there are various types of this condition:
Cervical myelopathy- This type of myelopathy affects the neck and is also the most common form of this condition. It’s generally caused by degeneration in the cervical spine, and it might lead to weakness, numbness, and tingling in your hands, arms, and legs.
Thoracic myelopathy- This type of myelopathy affects your mid-spine. It’s generally caused by bulging or herniated discs, bone spurs, or in some cases, spinal trauma. The signs and symptoms generally come on slowly, unless the cause of the compression is trauma. Some of these symptoms include numbness and weakness in the legs, loss of coordination, as well as difficulty in walking.
Lumbar myelopathy- This is the least common type of myelopathy, which affects the lower part of the spine, also known as the lumbar region.
Symptoms
When your spinal cord is compressed or injured, it might lead to loss of sensation, loss of function, as well as pain or discomfort in the area at or below your compression point. Some other symptoms of myelopathy include:
- Neck, arm, leg, or lower back pain
- A sensation of tingling, numbness, or weakness
- Increased reflexes in extremities or the development of abnormal reflexes
- Difficulty with fine motor skills, such as buttoning a shirt or writing
- Difficulty while walking
- Issues with balance and coordination
- Loss of urinary or bowel control
Generally, the exact symptoms depend on where in the spine the condition is present.
Causes
Myelopathy generally develops slowly due to the gradual degeneration of the spine, but it might also take an acute form or stem from a spine deformity that was already present at birth. The most common causes are generally degenerative spinal conditions, such as spinal stenosis, which is a narrowing of the bony passageways of the spine, through which the spinal cord, as well as the nerve roots, travel.
Central disc herniations may also result in compression on the spinal cord, which can lead to the development of myelopathy. Autoimmune disorders, like rheumatoid arthritis in the spine, may lead to degenerative changes as well, in the vertebrae which result in spinal cord compression and myelopathy.
Hernias, cysts, hematomas, as well as spinal tumors, including bone cancer, might also press on the spinal cord and lead to myelopathy.
Sometimes, acute myelopathy might also develop quickly due to spinal injury, spinal infection, inflammatory disease, neurological disorders, or even radiation therapy.
Diagnosis
Since the symptoms of myelopathy are not unique to the condition, your doctor is likely going to recommend the following tests for the diagnosis of the condition:
X-ray
An X-ray in order to rule out any other problems.
MRI
An MRI scan for a detailed look of the spine and spinal canal, which is able to show areas of stenosis.
Fluoroscopy
Fluoroscopy is used to reveal any abnormalities of the spinal cord. It is sometimes used instead of MRI for patients who are unable to sit inside the MRI machine.
Electromyogram
Electrical tests, such as an electromyogram might also be recommended. These tests measures how nerve stimulation in an arm, hand, leg or foot is connecting through the spinal cord to the brain.
In some cases, myelopathy is also added at the end of another underlying condition to indicate the involvement of your spinal cord. For example, your doctor might let you know that you are having cervical stenosis with myelopathy or thoracic disc disorder with myelopathy. Similarly, if your spinal cord is not involved, your diagnosis is going to say- ‘without myelopathy’.
If your myelopathy is caused as a complication of another disease, your doctor might refer to it in the terms of this disease. For example, diabetic myelopathy means that your spinal cord has been damaged due to your diabetes.
Treatment
Treatment is going to vary, depending on the type of myelopathy, how far the condition has progressed as well as the cause. For example, if a bacterial infection is the cause of your myelopathy, then treating the infection with antibiotics might treat the compression on the nerves. Some of the other possible treatments include:
A neck brace
Neck braces can provide support to your neck and also relieve pressure on the cervical part of your spinal cord. This is not going to remove the cause of the pressure, but it might delay the progression, and can also reduce the associated pain and symptoms.
Physical therapy
A physical therapist can help you with physical therapy exercises that might help to relieve pressure on your spinal cord.
Medications
Certain medications might help to reduce inflammation and also relieve symptoms. A steroid injection directly into the affected area is also an option for temporary relief.
Surgery
Surgery is also an option to remove any tumors or bone spurs or to repair herniated discs. It is the only treatment option that addresses the actual cause of the issue and may provide permanent relief.