Cervical Myelopathy – Causes, Symptoms, Treatment & Rehabilitation

What is Cervical Myelopathy?

Cervical myelopathy occurs when the spinal cord, which runs from the brain down the back and through the neck, becomes compressed in the cervical (neck) region. This compression affects the spinal cord's ability to transmit nerve signals to the rest of the body, causing a variety of symptoms. The most common cause of cervical myelopathy is degenerative changes in the cervical spine, such as disc herniation, bone spurs, or the narrowing of the spinal canal (spinal stenosis). These changes typically occur with aging but can also result from trauma, infection, or other spinal conditions.

Causes of Cervical Myelopathy

Cervical myelopathy can be caused by various conditions that place pressure on the spinal cord. The most common causes include:

• Degenerative Disc Disease: As we age, the discs between the vertebrae in the cervical spine lose hydration and elasticity, leading to bulging or herniated discs that can compress the spinal cord.

• Spinal Stenosis: The narrowing of the spinal canal due to degenerative changes or bone spurs can lead to compression of the spinal cord.

• Herniated Discs: A herniated or ruptured disc in the cervical spine can push against the spinal cord, causing pain, weakness, and neurological issues.

• Osteoarthritis: Age-related wear and tear can lead to the formation of bone spurs, which can compress the spinal cord and nerve roots.

• Trauma or Injury: Accidents, falls, or sports-related injuries can lead to fractures or dislocations of the vertebrae, causing damage to the spinal cord.

• Tumors or Infections: Although rare, tumors or infections in the cervical spine can cause compression of the spinal cord.

Symptoms of Cervical Myelopathy

The symptoms of cervical myelopathy can vary depending on the severity of the condition and the level of compression on the spinal cord. Early signs may be subtle but can progress over time if left untreated. Common symptoms include:

• Neck Pain: Pain or stiffness in the neck that may radiate to the shoulders or arms.

• Arm and Hand Weakness: Weakness or difficulty with fine motor skills in the hands, such as gripping objects, buttoning clothes, or writing.

• Numbness and Tingling: A sensation of numbness or tingling (paresthesia) in the arms, hands, or fingers, often described as “pins and needles.”

• Balance and Coordination Issues: Difficulty with walking, clumsiness, or loss of balance.

• Muscle Spasms: Muscle spasms in the neck, shoulders, or upper back.

• Loss of Reflexes: Reduced or absent reflexes in the arms or legs, which may be detected during a physical examination.

• Bowel or Bladder Dysfunction: In severe cases, cervical myelopathy can affect bowel or bladder control, indicating advanced spinal cord compression.

Diagnosis of Cervical Myelopathy

To diagnose cervical myelopathy, a healthcare provider will begin with a thorough medical history and physical examination. During the physical exam, they will assess your neurological function, reflexes, strength, and sensory responses.

Additional diagnostic tests that may be used to confirm the diagnosis include:

• X-rays: To assess the alignment of the cervical spine and detect bone spurs, fractures, or misalignments.

• MRI (Magnetic Resonance Imaging): The gold standard for visualizing soft tissue structures, MRI provides detailed images of the spinal cord, discs, and nerve roots, allowing doctors to identify areas of compression.

• CT Scan (Computed Tomography): A CT scan can provide detailed images of bone structures in the spine and is sometimes used when MRI is not available or appropriate.

• Electromyography (EMG): This test measures the electrical activity of muscles and can help identify whether there is nerve damage or compression.

Treatment Options for Cervical Myelopathy

The treatment of cervical myelopathy largely depends on the severity of the condition, the underlying cause of spinal cord compression, and the specific symptoms. Treatment options range from conservative (non-surgical) approaches to more invasive interventions, such as surgery.

Conservative Treatments:

1. Physiotherapy
   Physiotherapy plays a vital role in the management of cervical myelopathy. Our physiotherapists at Palms Physiotherapy & Allied Health will work with you to:

   • Improve neck strength and flexibility: Specific exercises to strengthen the neck, upper back, and core muscles to support spinal alignment and reduce strain.

   • Postural correction: Training you to maintain proper posture to prevent further strain on the cervical spine.

   • Manual therapy: Techniques such as joint mobilization and soft tissue massage to improve spinal mobility and relieve pain.

   • Traction therapy: Gentle neck traction can be used to relieve pressure on the spinal cord and nerve roots.

2. Exercise Physiology
   Exercise physiology focuses on improving overall body strength and endurance, particularly for those with cervical myelopathy. Treatment may include:

   • Developing a tailored exercise program to build strength and stability in the cervical spine and surrounding muscles.

   • Stretching routines to improve flexibility and reduce stiffness in the neck.

   • Enhancing coordination, balance, and function through targeted exercises to address any neurological deficits.

3. Pain Management
   Medications may be prescribed to manage pain and inflammation, including:

   • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): To reduce pain and swelling.

   • Corticosteroid injections: In some cases, steroid injections into the cervical spine may be used to reduce inflammation and alleviate pain.

4. Advanced Therapies
   At Palms Physiotherapy & Allied Health, we utilize cutting-edge technologies such as shockwave therapy and eMTT therapy to:

   • Stimulate the healing of damaged tissues and reduce inflammation.

   • Improve circulation and promote the repair of nerve and muscle tissues.

Surgical Treatments

For patients with severe cervical myelopathy or those who do not respond to conservative treatments, surgery may be recommended. Surgical options include:

• Anterior Cervical Discectomy and Fusion (ACDF): Removal of a herniated or degenerative disc along with fusion of the adjacent vertebrae to stabilize the spine.

• Laminectomy: Removal of part of the vertebra (lamina) to relieve pressure on the spinal cord.

• Posterior Cervical Decompression: In cases of spinal cord compression from the back of the spine, this surgery aims to alleviate pressure by removing bone or disc material.

• Cervical Artificial Disc Replacement: In some cases, a damaged disc may be replaced with an artificial disc to maintain motion in the spine.

How to Prevent Cervical Myelopathy

While some causes of cervical myelopathy, such as age-related degeneration or trauma, may be unavoidable, there are several measures you can take to reduce the risk of developing the condition:

• Maintain good posture: Proper alignment of your spine can help prevent unnecessary strain on the neck and reduce the risk of developing spinal issues.

• Exercise regularly: Focus on strengthening the muscles that support the cervical spine and improve flexibility to reduce the risk of injury.

• Ergonomic workplace setup: If you work at a desk or computer, set up your workspace so that you can maintain proper posture and avoid straining your neck.

• Avoid repetitive neck strain: Take breaks during activities that involve prolonged periods of neck bending or twisting, such as looking down at a phone or reading for long periods.

Get Professional Help for Cervical Myelopathy

If you suspect that you have cervical myelopathy, it’s important to seek medical attention. Early intervention can help reduce symptoms and prevent further damage to the spinal cord. At Palms Physiotherapy & Allied Health, we are here to guide you through every step of recovery, from diagnosis and treatment to rehabilitation.