Cervical Myelopathy

Cervical myelopathy is a disease of the spinal cord that may pass unnoticed.

It is due to bone ridges and disc protrusions in the spinal canal compressing the spinal cord to such an extent that the tissues of the cord degenerate.

The problem is that it is a painless condition and so often flies under the radar. Often misunderstood or missed all together. Yet it is the most common form of spinal cord dysfunction.

If untreated it can lead to severe loss of function; even tetraparesis.

Symptoms

Early

Initial symptoms are vague and because the disease commonly occurs in late middle age and older people, they may be passed off as infirmity, or due to alcohol or diabetes. Symptoms include:

• Tingling and numbness in the hands.
• An inability to manipulate finer things like buttons, keys, keyboards.
• Unsteadiness on the feet. Visual cues can overcome the neurological input from the legs but even so the patient can still feel unsteady.
• Loss of proper control of urinary function, though patients might be embarrassed to report this.

In association with myelopathy, patients might experience:

• Neck pain
• Pain in the arms due to nerve root compression

Tell-tale signs

Cervical myelopathy is a progressive disease, but may be stable for long periods, or result in gradual decline or in sudden, step-wise deterioration.

The key to successful detection is to eliminate other possible causes of tingling in the hands – diabetes, carpal tunnel syndrome and arthritis – and monitor hand function and gait.

The typical myelopathic gait is slightly stiff and awkward, like a robot, rather than wide-based.

If there is a definite impairment and loss of hand function and/or gait then send your patient in for a consultation.

Diagnosis

The clinical presentation is characteristic and can be confirmed with an MRI scan. If there is spinal cord compression then treatment is based on severity of functional impairment and rate of change.

If mild and stable, then monitoring the patient with an annual check-up may be appropriate. They can lead a full life for many years with just minor symptoms.

However, if at any point the patient experiences moderate levels of dysfunction or noticeable change, then the treatment is surgery.

Treatment

Surgery can restore loss of function and significantly ease nerve pain if present along with myelopathy.

If treatment is late and the patient has significant loss of function, then the prospect of restored function is less. Even with surgery.

The key to success is diagnose patients early enough and actively monitor their condition; then intervene if the symptoms deteriorate.

As always if you have any questions about your patient, please feel free to call me on 02 9650 4893.  I will return your call and discuss how I can help.

You can also reach me via ralphstanford@powspine.com.au.

Further Resources available include:

• Why I only operate when it makes a difference to my patient's quality of life
• Management Regime for Lumbar Disc Herniation & Sciatica
• Why your patients might be struggling to walk (Lumbar Canal Stenosis)
• Adult Spinal Deformities: Symptoms & Treatments
• Vertebroplasty – worth a rethink
• Caring for your patients in a Covid-19 world

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments. As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.

Posted 14 September 2020