The term myelopathy is used to describe any neurological deficit related to the spinal cord itself. The deficit(s) can be the result of either injury to the spinal cord or spinal degeneration, and symptoms associated with myelopathy can range from impaired sensation/movement and muscle weakness to paralysis and loss of organ function.
The onset of these symptoms may be sudden; for example, after a car accident or other trauma that causes injury to the spine. In most instances, however, symptoms develop gradually, worsening over time if the source of the spinal deficit is not treated.
A common cause of myelopathy is spinal stenosis, a progressive narrowing of the spinal canal. Disc herniation, in which the inner, gel-like material in the nucleus of the disc extrudes through the tougher, outer layer of the disc, also may impinge, or press into, the spinal cord. In the later stages of spinal degeneration, bone spurs and arthritic changes can greatly reduce the space available for the spinal cord within the spinal canal. The bone spurs may begin to press on the spinal cord and the nerve roots, which in turn affects the nerves’ ability to function normally.
Myelopathy also can be a complication associated with an underlying condition such as diabetes, lupus or aquired immune deficiency syndrome (AIDS).
Myelopathy is most commonly caused by spinal stenosis, which is a progressive narrowing of the spinal canal. In the later stages of spinal degeneration, bone spurs and arthritic changes make the space available for the spinal cord within the spinal canal much smaller. The bone spurs may begin to press on the spinal cord and the nerve roots, and that pressure starts to interfere with how the nerves function normally.
For many people who develop myelopathy as a result of degenerative changes in the spine, encountering difficulties when trying to do their normal, everyday activities – particularly those that require coordination or fine-motor skills – is often the first sign that something’s wrong. For example, if it’s become progressively harder for you to go up and down stairs, pick up and/or hold objects or fasten the buttons on your clothes, please see your doctor as soon as possible, as these can be warning signs of myelopathy related to nerve injury. And the longer the source of the injury remains untreated, the greater the potential for permanent nerve damage.
Symptoms of myelopathy as a result of a sudden spinal trauma, such as an accident or fall, can include the total or partial loss of sensation, movement and function in the muscles, tissues and organs served by the nerves originating in the area of the spinal cord affected by the injury. Injury to the upper areas of the spinal cord can result in myelopathy that affects multiple systems in the body.
To determine if myelopathy is the cause of your symptoms, your doctor may, in addition performing a physical exam, recommend a diagnostic test such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
When myelopathy has been diagnosed, spine surgery is typically recommended for patients who show evidence of muscle weakness caused by spinal cord compression. The goal of surgery is alleviate your symptoms and prevent further damage by removing the source of pressure on the spinal cord.
Spinal surgeons perform a variety of procedures to achieve spinal decompression. When determining the optimal surgical procedure, a surgeon will consider patient pathology (the structural and functional changes that led to the patient’s neurological dysfunction), the level or levels of the spine affected, the patient’s medical history and his or her surgical experience and training.
Today, spinal decompression also can be performed using a minimally invasive technique that allows your spine surgeon to dilate the muscles surrounding your spine rather than stripping the muscles away from the spine.
The benefits of spine surgery, however, must be weighed against the risks. Your surgeon will be able to discuss the risks and benefits of surgery with you, and the likely results of operative versus non-operative treatment.