Because myelopathy is a condition that compresses the spinal cord, it can be very dangerous and cause symptoms that cannot be reversed. It can be caused by trauma or a degenerative disease, such as spinal stenosis or disc herniation. When any part of the spinal cord is compressed, it causes nerve dysfunction along the spinal cord resulting in pain, loss of balance and coordination and numbness in the area around the compression point. For these reasons, the spine neurosurgeons at Neurosurgery One almost always recommend immediate surgery to relieve the pressure and stop any permanent damage.
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ArticlesWhat are risk factors of myelopathy?
As you age, inflammation, arthritic illness, bone spurs, and the flattening and bulging of the spinal discs between the vertebrae can put pressure on the spinal cord, causing myelopathy. Myelopathy typically develops slowly as a result of the gradual degeneration of the spine. But it also can result from trauma or a malformation present at birth.
Some other common causes of myelopathy include:
- Instability of elements within the spinal column
- Spinal stenosis, a narrowing of the passageways of the spine through which the spinal cord travels
- Spinal infections
- Disc herniation and degeneration
- Spinal cysts
- Autoimmune disorders, including rheumatoid arthritis
The following factors also can increase your risk of developing myelopathy:
- Smoking
- Advanced age
- Excess weight or obesity
- Participating in intense sports or physical activities, such as gymnastics or football
- Inactivity
- Repetitive, strenuous motions performed over prolonged periods
- Improperly lifting heavy objects
What are common symptoms of myelopathy?
When the spinal cord is compressed or injured, it may cause a loss of sensation, loss of function, and pain or discomfort in the area at or below the compression point.
Myelopathy symptoms may be associated with:
- Neck, arm, leg, or mid back pain
- Difficulty with fine motor skills, such as writing or buttoning a shirt
- Increased reflexes in extremities or the development of abnormal reflexes
- Difficulty walking
- Loss of urinary or bowel control
- Issues with balance and coordination
- A heavy feeling in the legs, causing an inability to move quickly
- Muscle weakness
In many cases, symptoms will vary depending on where in the spine myelopathy is present. For example, myelopathy that occurs in the neck, or cervical area, is likely to cause symptoms in the neck and arms, including weakness, numbness, and tingling. But it can also include the legs.
Myelopathy that occurs in the middle back will produce symptoms below that area, including pain and cramping in the legs. However, it cannot affect the arms.
Are there nonsurgical treatments for myelopathy?
Myelopathy is usually not treated with noninvasive therapy, because progression of any symptoms at diagnosis is not often reversible. Therefore, surgical treatment is usually considered earlier than in other spinal conditions. If your myelopathy is in the neck, your physician may recommend bracing to minimize movement that may result in increased pain.
What type of surgery relieves the pain of myelopathy?
At Neurosurgery One, our Denver spine surgeons generally take a conservative approach in other areas but nearly always recommend surgery for myelopathy. For myelopathy in the neck, or cervical area, options include:
- Decompression Surgery: There are many types of decompression spine surgery; all are used to remove pressure on spinal nerves.
- Discectomy: This surgery is performed to remove a damaged spinal disc. Neurosurgery One neurosurgeons often perform this procedure using minimally invasive techniques, which is called a microdiscectomy.
- Laminectomy. In this procedure, a bone on the back of the spine that protects the spinal canal is removed to open up space in the spinal canal. Most often, the part of the spine causing a problem is in front of the spinal cord. Therefore, it is the best option for only a select group of patients.
- Spine Fusion: This procedure permanently fuses two or more vertebrae together so that movement causing pain is eliminated.
- Foraminotomy: A surgery to remove material that is causing constriction of the spinal column.
- Artificial Disc Replacement: During this surgery, your neurosurgeon removes the diseases or injured disc and replaces it with a specially fitted artificial disc.
- Anterior cervical decompression and fusion. This procedure involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A fusion surgery is done at the same time as the discectomy operation in order to stabilize the cervical segment. The procedure has a 90 to 95 percent success rate for pain reduction. Learn more about anterior cervical decompression and fusion, or ACDF.
For advanced myelopathy caused by stenosis at many levels, without nerve involvement, your spine surgeon may recommend a surgical procedure called laminoplasty to increase the space within your spinal cord.