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Cervical Myelopathy (spinal cord compression)

Cervical Myelopathy (spinal cord compression) is a clinical syndrome that results from the disruption or interruption of the normal signals transmitted from the brain through the spinal cord.  This can cause symptoms in the arms, legs, and bowel and bladder function depending on the severity of the problem.

There are many potential causes of cervical myelopathy but the most common cause is what is known as cervical spondylotic myelopathy which is caused by arthritic and degenerative changes of the spine.  This may also be seen in patients with a large herniated disc that pushes on the spinal cord or in patients with a condition known as congenital spinal stenosis (born with a smaller than average spinal canal) that develop disc bulging or arthritis.

The spinal canal is an enclosed tube through which the spinal cord runs from the brain down towards the lower back.  There is fluid that surrounds the spinal cord which helps nourish and protect it from trauma.  Over a period of time, the spinal canal may become narrowed due to degeneration of the discs, formation of bone spurs (osteophytes), bulging or herniated discs, and thickening of the surrounding ligaments of the spine.  As a result of this, the spinal cord can be compressed and the resulting clinical signs of myelopathy can occur.

Clinical symptoms may include numbness or burning of the hands, arm and leg weakness (dragging of the leg), hand weakness and clumsiness, chest wall numbness, balance issues, and urinary urgency.  Diagnosis is made with a physical examination including checking reflexes, watching the patient walk, and specific tests in addition to radiologic testing to confirm the diagnosis.  Sometimes on an MRI, there can be actual changes seen in the spinal cord.

Treatment of myelopathy is aimed at preventing the symptoms from getting worse and involves a surgical procedure.  Often times, a disability that develops may not get better even with a surgery to take pressure off the spine.  Surgery is performed in patients that have developing symptoms and radiographic studies to confirm the diagnosis.  The exact procedure is determined based on the pathology causing the spinal cord compression.