We tend to take our necks for granted. That is, until we wake up and find we can only turn our heads a couple of degrees (or not all)! Cervical myelopathy is a condition that goes beyond a simple morning-time crick in your neck. Chronic neck pain can make daily life challenging and reduce your overall quality of life. Here’s what you need to know about cervical myelopathy, including common symptoms and our treatment options. If you need more information, get in touch with the team at North Texas Neurosurgical Consultants. We’re here to help.
Do I have cervical myelopathy?
The vertebrae of our cervical spine are vulnerable, with four separate joints in each vertebra that help them move (two facet joints and two unconvertable joints). The intervertebral discs provide cushioning between these vertebrae. Ligaments and tendons provide stability to the spinal column. As we age, our intervertebral discs naturally begin to flatten and lose their supportive bounce. Ligaments loosen and lengthen and may struggle to recover from overuse, strain, or injury.
Cervical myelopathy (also called cervical spondylotic myelopathy or spinal cord compression) is compression of the spinal cord in the neck due to this wear and tear that occurs as we age. It can also occur due to other issues, as noted below.
This compression can lead to cervical myelopathy symptoms that include:
- Difficulty grasping objects
- Tingling, numbness, or weakness in the hands and arms
- Difficulty walking (no dizziness but an inability to coordinate the body)
- Stiffness in the neck
- Fewer fine motor skills
As the condition progresses, pain may radiate down the arms, across the shoulders, and into the upper back. There are generally four stages of cervical myelopathy development.
- Disc degeneration: Discs start to weaken and deteriorate
- Joint degeneration: Joints experience more stress with less cushion and can develop bone spurs
- Ligament changes: Ligaments stretch and become strained
- Deformity: Kyphosis, an excessive outward curve of the cervical spine, can be the final presentation of this condition
What are common cervical myelopathy causes?
The most common cause of cervical myelopathy is age and normal degeneration of the cervical vertebrae.
This type of pain usually begins between the ages of 40 and 50, but 85% of patients over 65 have measurable degeneration in their necks (even if they don’t have symptoms). The natural aging process, when combined with other risk factors, can cause more damage as the discs continue to deteriorate.
Other cervical myelopathy causes related to age include cervical disc degeneration (that can lead to bone spurs), herniated or bulging discs, and cervical stenosis with myelopathy. Cervical stenosis is a narrowing of the spinal column that compresses the spinal cord.
In some cases, diseases that are not related to disc degeneration or age can lead to the same symptoms as cervical myelopathy. Rheumatoid arthritis, for example, is an autoimmune disorder where the immune system attacks healthy tissues (in this case, the synovium, a membrane that lines the joints). As the synovium breaks down, the facet joints may begin to deteriorate, and spondylolisthesis can occur.
Injuries received in a car accident are also a common cause of cervical myelopathy, especially rear-end collisions.
Other risks factors for cervical myelopathy include:
- Excessive driving
- Occupational hazards, such as repeated heavy lifting and twisting
- Professional athletes (with higher risk of injury to the neck)
Lumbar spinal stenosis is also present in 20% of people who have cervical myelopathy, indicating that lumbar spinal stenosis is a risk factor as well. Chronic, head-forward posture also places tremendous strain on the cervical spine and can result in cervical myelopathy as well in severe cases.
Our approach to treatment and cervical myelopathy surgery
North Texas Neurosurgical Consultants believes in a balanced, measured approach to cervical myelopathy treatment, starting with the least invasive treatments (e.g., diet, exercise, and physical therapy) before trying more drastic measures. Many patients experience pain relief and increased mobility with these non-invasive treatments.
There are a number of different surgical approaches to cervical myelopathy treatment that can be considered if other more conservative treatments have been unsuccessful.
Spinal fusion is a surgical technique that may help when other conservative treatment approaches have failed for severe forms of pain.
For cervical myelopathy, the vertebrae are moved into the correct position and a bone graft is used to replace the damaged or worn out disc. Special hardware holds the bones in place while they heal, giving the bones time to come together.
When cervical myelopathy is causing painful pressure on the nerves, spinal cord decompression surgery can create space between your vertebrae.
Opening up this space relieves painful pressure on the spinal cord. Your surgeon may perform spinal fusion at this time for increased stability, too.
Anterior cervical discectomy and fusion is a procedure that removes what remains of a damaged disc and fuses at least two of the cervical vertebrae together to provide more stability and decrease (or eliminate) pain.
To access the cervical vertebrae, your doctor will make a small incision in the throat. This is a safer way to perform cervical fusion because operating in the back of the neck can damage neck muscles or the spinal column itself. Moving the neck tissue aside, your surgeon then removes the damaged disc.
A replacement disc is added between the vertebrae. This disc can be made of bone from the patient, bone from a donor, or bone created in a lab. Held in place by hardware for added stability, natural bone will eventually fuse together to become one vertebra, in the same manner as a broken bone knits itself together.
Get help with your cervical myelopathy pain
If you are experiencing pain related to untreated cervical myelopathy pain, we can help. Talk to your doctor to determine if you are a good candidate for any of these types of cervical myelopathy surgery or treatments.
At North Texas Neurosurgical Consultants, Dr. Rosenstein works with patients to find the treatment that provides the highest standard of pain relief, today and going forward. Our team is in the Dallas/Fort Worth area, but welcome patients from all over Texas.
Get in touch today for expert help with managing your pain.