Myelopathy – Spinal Cord Dysfunction from Compression

Myelopathy – Spinal Cord Dysfunction from Compression

The spinal cord is one of the most vital structures in the human body. It carries nerve signals between the brain and the rest of the body, controlling movement, sensation, and reflexes. When the spinal cord is compressed or damaged, its function can be disrupted, leading to a condition known as myelopathy.

Unlike common spine problems that mainly affect bones or discs, myelopathy involves the spinal cord itself, making it a serious condition that requires timely diagnosis and treatment. Left untreated, it can cause permanent nerve damage, paralysis, or loss of bladder and bowel control.

This blog explains what myelopathy is, its causes, symptoms, diagnosis, treatment options, and prevention strategies.

What is Myelopathy?

Myelopathy refers to any neurological deficit related to the spinal cord, usually caused by compression, inflammation, or injury. It can occur in different regions of the spine:

  • Cervical Myelopathy – Compression in the neck region.

  • Thoracic Myelopathy – Compression in the middle back.

  • Lumbar Myelopathy – Rare, since the spinal cord usually ends around the first or second lumbar vertebra.

Among these, cervical myelopathy is the most common and often linked to degenerative changes.

Causes of Myelopathy

Several conditions can compress or damage the spinal cord, leading to myelopathy:

  1. Degenerative Disc Disease

    • Herniated or bulging discs pressing on the spinal cord.

  2. Spinal Stenosis

    • Narrowing of the spinal canal due to age-related changes.

  3. Osteoarthritis & Bone Spurs

    • Extra bone growth can pinch the cord.

  4. Trauma or Injury

    • Fractures, dislocations, or whiplash injuries.

  5. Tumors

    • Benign or malignant growths within or near the spinal cord.

  6. Infections

    • Spinal abscesses or tuberculosis affecting the cord.

  7. Inflammatory Disorders

    • Multiple sclerosis or autoimmune conditions.

  8. Congenital Abnormalities

    • Conditions like Chiari malformation or congenital stenosis.

Risk Factors

Certain groups are at higher risk of developing myelopathy:

  • Older Adults – Age-related degeneration is the leading cause.

  • People with Osteoporosis or Arthritis – More prone to spinal changes.

  • Athletes – High risk of traumatic spinal injuries.

  • Patients with Cancer – Tumors can metastasize to the spine.

  • People with Untreated Infections – Spinal tuberculosis, for example, is common in some regions.

Symptoms of Myelopathy

The symptoms vary depending on the location and severity of spinal cord compression but typically include:

  1. Neck or Back Pain – Persistent and sometimes radiating.

  2. Weakness – In arms, legs, or both.

  3. Numbness and Tingling – In hands, arms, or lower body.

  4. Clumsiness – Difficulty with fine motor skills (buttoning shirts, writing).

  5. Balance Problems – Unsteady gait, frequent falls.

  6. Muscle Spasms or Stiffness – Due to nerve dysfunction.

  7. Loss of Bladder or Bowel Control – A late and serious sign.

  8. Paralysis – In severe untreated cases.

⚠️ Symptoms usually progress slowly, but sometimes they can worsen suddenly after a fall or injury.

Complications if Left Untreated

Delaying treatment for myelopathy can result in:

  • Permanent spinal cord damage.

  • Chronic pain and weakness.

  • Severe mobility problems or paralysis.

  • Loss of bladder and bowel function.

  • Reduced independence and quality of life.

Diagnosis of Myelopathy

Doctors use a combination of history, examination, and imaging to diagnose myelopathy:

  1. Medical History

    • Onset and progression of symptoms.

  2. Physical Examination

    • Reflexes, muscle strength, coordination, and sensation.

  3. MRI Scan

    • The gold standard for detecting spinal cord compression.

  4. CT Scan

    • Helpful for bone-related issues like fractures or spurs.

  5. X-rays

    • Show alignment problems or degenerative changes.

  6. Electromyography (EMG) & Nerve Conduction Tests

    • Assess nerve function and rule out peripheral nerve disease.

Treatment of Myelopathy

The choice of treatment depends on the severity of compression and symptoms.

Non-Surgical Management

For mild cases or early-stage myelopathy:

  • Medications

    • Anti-inflammatory drugs to reduce swelling.

    • Pain relievers and muscle relaxants.

  • Physiotherapy

    • Exercises to strengthen muscles and improve mobility.

  • Lifestyle Modifications

    • Avoiding heavy lifting or strenuous activities.

⚠️ Non-surgical treatment can only manage symptoms temporarily; it does not reverse spinal cord compression.

Surgical Treatment

Surgery is often required to decompress the spinal cord and prevent worsening symptoms. Options include:

  1. Anterior Cervical Discectomy and Fusion (ACDF)

    • Removing a damaged disc from the front of the neck.

  2. Laminectomy

    • Removing part of the vertebra to enlarge the spinal canal.

  3. Laminoplasty

    • Reshaping the vertebra instead of removing it.

  4. Tumor Removal

    • If a spinal growth is the cause.

  5. Spinal Stabilization (Fusion)

    • To prevent instability after decompression.

Surgery is most effective when performed before severe nerve damage occurs.

Recovery and Prognosis

  • Early Surgery = Better Results: Patients treated before severe disability often regain strength and mobility.

  • Rehabilitation: Physiotherapy, occupational therapy, and walking aids may be required post-surgery.

  • Long-Term Outlook: Some residual numbness or weakness may remain, but progression is usually halted.

Prevention of Myelopathy

While not all causes can be prevented, certain steps lower the risk:

  • Maintain good posture and ergonomic work habits.

  • Strengthen core and back muscles with regular exercise.

  • Treat osteoporosis to avoid fractures.

  • Avoid repetitive strain or excessive neck flexion.

  • Seek early medical care for persistent neck or back pain.

Living with Myelopathy

For people with chronic myelopathy:

  • Pain Management – Medications and therapy.

  • Mobility Aids – Canes, walkers, or braces if needed.

  • Bladder and Bowel Training – In severe cases.

  • Psychological Support – To deal with anxiety or depression.

Support from family, caregivers, and rehabilitation specialists makes a significant difference in daily life.

Conclusion

Myelopathy is a serious condition that occurs when the spinal cord is compressed or damaged. It can affect balance, movement, sensation, and bladder control. Unlike routine back pain, myelopathy signals spinal cord dysfunction, making it urgent to seek specialist care.

With timely diagnosis and treatment – often surgery – many patients can halt disease progression and regain independence.

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