Myelopathy

What is myelopathy?

Myelopathy is the medical name for pressure on your spinal cord, most often in your neck. It happens when nearby bone, disc or other tissue squeezes the cord and stops it working properly, which can cause pain, numbness or weakness in the parts of your body it controls.

What are the symptoms of myelopathy?

Myelopathy affects everyone differently, depending on which part of your spinal cord is under pressure and how much. You might notice:

• pain or stiffness in your neck or back
• tingling, numbness or pins and needles in your arms, hands, legs or feet
• weakness in your arms or legs
• clumsy hands, or trouble with fine movements such as doing up buttons, writing or picking up small objects
• balance or coordination problems, including feeling unsteady on your feet or struggling to walk quickly
• occasional electric shock type pains down your arms or legs, particularly when you bend your head forward.

A small number of symptoms need same day medical care. These are covered under 'When should I see a doctor?' below.

What are the causes of myelopathy and who is at risk?

The most common cause is everyday wear and tear on your spine as you get older, sometimes called spondylosis or arthritis of the spine. This can lead to bony growths (osteophytes) or a bulging disc pressing on your spinal cord. Other causes include:

• a slipped or herniated disc that suddenly presses on your spinal cord, which can bring on symptoms quickly
• rheumatoid arthritis
• a spinal canal that's naturally narrow, including one you were born with
• infection or inflammation
• a tumour
• a traumatic injury, such as a fall.

Myelopathy can affect anyone at any age. Degenerative types are more common in adults over 40, in men, and in people of Asian heritage over the age of 30. If you have age-related cervical myelopathy, you're typically diagnosed around age 64.

Are there different types of myelopathy?

Myelopathy is named after the part of your spine where the pressure happens.

• Cervical myelopathy affects your neck. This is the most common type, and it's usually caused by wear and tear in the spine as you get older. You may hear it called degenerative cervical myelopathy or cervical spondylotic myelopathy.
• Thoracic myelopathy affects the middle part of your spine, around your upper back.
• Lumbar myelopathy affects your lower back.

How is myelopathy diagnosed?

If you see a doctor about these symptoms, they'll ask about your medical history and carry out a physical and neurological examination. This may include checking your strength, reflexes and balance, testing your dexterity (skill with fine hand movements), and watching how you walk. They may then arrange one or more of the following tests:

• an X-ray, MRI or CT scan, to get a picture of your spine
• a myelogram, which uses a special dye alongside imaging to show how your bones and soft tissue relate to each other
• nerve tests, such as electromyography or evoked potentials, to check how well messages travel between your brain and body.

How is myelopathy treated?

Non-surgical treatment

Your doctor will usually try non-surgical options first, unless your symptoms are severe. These can ease your symptoms, but won't relieve the pressure on your spinal cord itself. Options include:

• wearing a neck brace or collar
• physiotherapy
• medication, such as anti-inflammatory painkillers (NSAIDs), steroid medicines (corticosteroids) or other pain relief.

Surgical treatment

If non-surgical treatment doesn't help, or your symptoms are severe, your surgeon may recommend an operation to relieve the pressure on your spinal cord. You may be offered surgery if you have severe pain, muscle weakness, numbness, or problems with your balance, walking or fine hand movements.

Depending on your symptoms, general health and age, your surgeon may recommend:

• diskectomy: removing all or part of a damaged disc
• disk replacement: taking out a damaged disc and fitting an artificial one
• laminectomy: removing part of a bone in your spine to create more room for your spinal cord
• laminoplasty: reshaping bone in your spine to create more space, rather than removing it
• spinal fusion, including ACDF (anterior cervical discectomy and fusion), a common procedure for the neck: joining two or more bones in your spine together so they no longer move against each other.

Your surgeon will explain the risks and benefits before you decide. There's no single treatment that works for every cause of myelopathy. After surgery, you'll need to avoid heavy lifting and strenuous activity until your surgeon says it's safe.

When should I see a doctor?

Contact your GP or physiotherapist if you notice any of the following, especially if they're gradually getting worse:

• changes in the way you walk, or new clumsiness or balance problems
• new or worsening pain in your neck or back
• numbness, tingling or weakness in your hands, fingers, feet or toes.

Some symptoms occur suddenly and need emergency care. Go to your nearest emergency department straight away if you develop:

• sudden weakness, such as being unable to lift your arms or legs, or grip objects
• a rapid change in how you walk, such as tripping, falling, or your legs feeling heavy or stiff
• new balance problems, such as stumbling or feeling like you're drunk
• loss of feeling or pins and needles between your inner thighs or around your genitals
• changes to your bladder or bowel control, such as difficulty passing urine, leaking, or loss of sensation
• changes to sexual function, such as difficulty getting an erection or reaching orgasm.