• Clinical science

Cervical myelopathy

Summary

Myelopathies are neurological disorders due to compression of the spinal cord. Myelopathies can be cervical, thoracic, or lumbar. Cervical myelopathy is the most common type of myelopathy in adults above 55 years of age. Etiologies include degenerative changes of the spine, spinal trauma, infection, tumors, and autoimmune disorders. Onset can be acute, step-wise, or insidious. Clinical features vary depending on the level of the lesion and include local pain, stiffness, and impaired sensation, hypotonia, and hyporeflexia at the level of the lesion, and spasticity and hyperreflexia below the level of the injury level. Diagnosis is confirmed by MRI or myelography. Treatment includes conservative management for degenerative disease or immediate surgical decompression in acute compression.

Etiology

References:[1]

Pathophysiology

  • Intramedullary or extramedullary (i.e., originating from within or outside the spinal cord) mass lesions compress the spinal cord and impair its perfusion; mechanic and ischemic axonal injury → intramedullary edema → further narrowing of the medulla

References:[2]

Clinical features

Features depend on the level of compression and the onset may be sudden (e.g., with trauma), step-wise, or slowly progressive (e.g., degenerative diseases)

Damage to the spinal cord and the nerve roots (radiculopathy) often occur simultaneously!

Pain is not commonly an early symptom. Therefore patients may not be diagnosed until myelopathy becomes severe!

References:[3][1]

Diagnostics

  • MRI of the spine: : determines the site of narrowing of the medulla and the underlying pathology
  • Myelography: (possibly with CT): when MRI is contraindicated (e.g., in patients with metal implants)

References:[4][2]

Differential diagnoses

References:[4][5]

The differential diagnoses listed here are not exhaustive.

Treatment

  • Conservative treatment: (i.e., analgesia; , corticosteroid; therapy , bracing; , physiotherapy; ): indicated perioperatively; , for severe cases (e.g., degenerative cervical myelopathy ), and mild cases
  • Decompression surgery: : typically indicated in acute or advanced cases

Acute cervical myelopathy with loss of bladder and bowel control is a neurological emergency that demands immediate surgical decompression!

References:[3][5]