Cervical myelopathy is damage to the part of the spinal cord that is in the neck. The cervical spine begins at the base of the skull. It extends to the first seven vertebrae.

Cervical Spine

Causes

Cervical myelopathy is caused by:

A slipped disc
Cervical discs that are worn, known as degeneration
Tumors inside the spinal cord or compressing on the spinal cord
Bone spurs
Dislocation or fracture of the neck
Traumatic injury to the cervical spine
Autoimmune disease, such as transverse myelitis, multiple sclerosis, or neuromyelitis optica

Risk Factors

Factors that may increase your risk of cervical myelopathy include:

Infections
Ischemia—restriction of blood supply
Autoimmune disorders, such as rheumatoid arthritis, multiple sclerosis, neuromyelitis optica; or other conditions, such as vascular disease or degenerative disease
History of bone or back problems
Being born with a narrow spinal canal
Job or sport involving regular stretching and straining of spine
History of cancer involving the bones

Symptoms

Symptoms may include:

Pain in the shoulder and arms
Tingling or numbness in the arms and legs
Trouble walking or balancing
Muscle weakness
Problems flexing the neck
Lightheadedness
Problems with fine motor control, such as buttoning a shirt
Irregular movements
Bowel or bladder problems
Weakness below the waist or in all 4 limbs

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. It will focus on any muscle weakness. A neurological exam may also be done to check your:

Reflexes
Vision
Mental state

Imaging tests evaluate the spine and surrounding structures. These may include:

Other tests may include:

Electromyography (EMG)
Somatosensory evoked potentials
Visual evoked potential test (VEP)

Treatment

Talk with your doctor about the best treatment plan for you. This may involve:

Treating the cause of the myelopathy
Improving functions that you have lost
Reducing or managing pain
Doing strengthening exercises
Teaching you ways to reduce injuries
Helping you learn ways to cope with the condition

Surgery

If there is structural pressure on the spinal cord, you may need surgery right away. This is to attempt to avoid lasting injury. There are many different kinds of surgery and procedures to stabilize the neck, such as:

Discectomy —to remove part of an intervertebral disc that is putting pressure on the spinal cord or nerve root
Laminectomy —a surgical procedure to remove a portion of a vertebra, called the lamina
Fusion of the vertebrae

Cervical Fusion

Screws and a plate prevent the vertebrae from putting pressure on the spinal cord.

Nonsurgical Approaches

Nonsurgical approaches may include:

Physical therapy
Occupational therapy
Other approaches, such as ultrasound therapy, heat therapy, or electrical stimulation
Plasmapheresis

Medication

Medications may help to relieve symptoms. Common medications include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
Corticosteroids
Rituximab—This is an antibody used to treat some autoimmune disorders.

Other medications that affect the immune system are also sometimes used.

Prevention

It is difficult to prevent this condition. Follow these guidelines to prevent accidents and strains:

Ask about ergonomics in your workplace. Some examples of ergonomics include learning correct lifting techniques, improving your posture, and sitting correctly.
Avoid contact sports if you have had disc disease with compression of the spinal cord.
Limit neck movement.
Take these measures to prevent falls:
- Remove throw rugs and other obstacles from the floor.
- Install a night light near the stairs and your bed.
- Install handrails in the tub and shower.
- Rise slowly from a seated or lying position.

RESOURCES:

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

United Spinal Association
http://www.spinalcord.org

CANADIAN RESOURCES:

Canadian/American Spinal Research Organizations
http://www.csro.com

Health Canada
https://www.canada.ca

References:

Cervical myelopathy. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/orthopaedic_disorders/CervicalMyelopathy_22,CervicalMyelopathy. Accessed November 8, 2017.

Lumbar spondylolysis. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated July 16, 2015. Accessed November 8, 2017.

Older adult falls. Centers for Disease Control and Prevention website. Available at:
...(Click grey area to select URL)
Updated October 11, 2016. Accessed November 8, 2017.

Pollard H, Hansen L, Hoskins W. Cervical stenosis in a professional rugby league football player: a case report. Chiropr Osteopat. 2005;13:15.

Young WB. Clinical diagnosis of myelopathy. Semin Ultrasound CT MR. 1994;15(3):250-254

Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064-1070.

Last reviewed November 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 12/20/2014

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