Cervical Spondylotic Myelopathy
Cervical = having to do with the spine in the neck
Spondylotic = having to do with spinal degeneration
Myelopathy = damage to the spinal cord
Cervical spondylotic myelopathy is damage to the spinal cord in the neck.
The spinal cord begins at the base of the brain and runs down through the spinal canal, an enclosed tube made of bones, cartilage and ligament tissue of the spine. The spinal cord transmits electrochemical signals between the brain and the body. The spinal cord is surrounded by a few millimeters of fluid-filled space, which helps to protect it from trauma and allows flexibility without injury to the spinal cord.
Myelopathy, or damage to the spinal cord, can occur for a number of reasons. The most common cause of myelopathy is when the spinal cord is compressed, or squeezed. This compression disrupts normal nerve transmission. Arthritis of the spine, or spondylosis is the most common reason the spinal cord is compressed.
Spondylosis refers to degenerative, or age-related, changes in the spine. These changes include disc degeneration, bone spurs, and thickened ligaments.
Cervical spondylotic myelopathy, therefore, is myelopathy (spinal cord damage) caused by spondylosis (degeneration) in the cervical spine (neck). It affects the fibers of the spinal cord that transmit impulses to the arms, hands, and legs. As a result, it can cause weakness, numbness, tingling, or rarely, pain in these areas.
The symptoms of cervical spondylotic myelopathy depend on the level(s) of the spinal cord that are involved and the pattern of the involvement.
Symptoms may include:
- numbness of the hands
- clumsiness of the hands
- arm and/or hand weakness
- leg stiffness (“walking like a robot”)
- loss of balance
- urinary urgency
- neck pain–may be present but is not usually a significant complaint
The timing of the appearance of symptoms and progression varies from person to person. The rate of progression of symptoms may also change over time. Symptoms may progress rapidly for a period of time and then enter a period of stability. Alternatively, the symptoms may progress slowly but steadily.
Since cervical spondylotic myelopathy may cause similar symptoms to other conditions, and patients may present with a variety of symptoms, the diagnosis of cervical spondylotic myelopathy can be difficult. The surgeon will evaluate the patient’s history and perform an examination. The surgeon may order a variety of diagnostic procedures to rule out other possible conditions. Possible tests include:
- Post-myelography computed tomography (myelo-CT): consists of X-rays taken after the injection of radio-opaque contrast material into the spinal fluid via a lumbar puncture. This procedure may provide useful images of the interior of the spinal canal, and can reveal indentations of the spinal fluid sac caused by bulging discs or bone spurs that might be compressing the spinal cord or nerves.
- Magnetic resonance (MR) imaging scan: the best method of imaging the spinal cord, nerve roots, intervertebral discs, and ligaments. MR scans may be used to obtain high-resolution images of the cervical spinal canal and the spinal cord.
Cervical spondylotic myelopathy is caused by spondylosis, or age-related degeneration. In fact, cervical spondylotic myelopathy is the most common spinal disorder in Americans over 55 years of age. Common degenerative changes include bone spurs (osteophytes), disc bulges, and thickened ligaments. These changes may narrow the spinal canal, encroaching on the fluid-filled space around the spinal cord. Eventually this stenosis, or narrowing, can impinge on the spinal cord itself. The resulting compression (squeezing) damages the delicate fibers of the spinal cord.
The primary treatment of cervical spondylotic myelopathy is to decompress the spinal cord (remove the pressure from it). The surgery is performed to prevent the progression of symptoms. In other words, the goal of surgery is simply to prevent symptoms from getting any worse. Damage that has occurred in the spinal cord itself can heal, but it is impossible to predict the degree of healing. The prognosis is different in every case.
The neurosurgeons at the Spine Hospital at the Neurological Institute of New York are experienced in evaluating cases of cervical spondylotic myelopathy, forming individualized treatment plans, and conducting decompression surgery. The exact procedure chosen is based on the location and type of stenosis, the overall alignment of the cervical spine, and many other factors.
The surgeon may perform surgery from the front of the neck, which is called an anterior approach. These surgical procedures may include the following:
- anterior cervical discectomy and fusion
- anterior cervical corpectomy
In other situations, the surgeon may perform surgery from the back of the neck, which is called a posterior approach. These surgical procedures may include the following:
- cervical laminectomy
- cervical laminectomy and fusion
- cervical laminoplasty
In some cases, the surgeon may perform surgery using both an anterior and a posterior approach.
The surgeon will provide information on the available surgical procedures and will tailor the treatment to each patient and case.