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Myelopathy
What Is Myelopathy?
Myelopathy in Minnesota refers to a condition involving compression of the spinal cord. The word myelopathy (my-uh-LOP-uh-thee) comes from the prefix myelo–, meaning “spinal cord,” and the suffix –pathy, meaning “suffering.” Myelopathy is sometimes confused with radiculopathy.
The difference is that myelopathy involves spinal cord compression, while radiculopathy involves compression of the spinal nerves. Myelopathy may also be confused with myopathy. However, the prefix myo– refers to muscle, meaning myopathies are muscular disorders rather than spinal cord disorders.
Myelopathy causes pain, interferes with normal neurologic functioning, and can place patients at a high risk of disability. The underlying conditions responsible for myelopathy often worsen over time if left untreated. As spinal cord compression progresses, neurologic functioning may continue to decline. Because of this, physicians classify myelopathy as a progressive disorder. Many doctors now refer to the condition as degenerative cervical myelopathy (DCM).
Types of Myelopathy
Myelopathy in Minnesota may be categorized based on the location of spinal cord compression:
- Lumbar Myelopathy: In most people, the spinal cord ends just above the lumbar spine. Because of this anatomy, lumbar myelopathy is rare and typically occurs only in patients with unusual spinal anatomy.
- Thoracic Myelopathy: Thoracic myelopathy affects the thoracic, or mid-back, region of the spine. Although possible, it is much less common than cervical myelopathy.
- Cervical Myelopathy: Cervical myelopathy refers to spinal cord compression occurring in the cervical spine, or neck region.
How Common Is Myelopathy?
Cervical myelopathy in Minnesota and throughout the United States affects an estimated 5% of adults over age 40. In adults age 55 and older, most cases are related to spondylosis. As the population continues to age, both myelopathy and surgical correction for myelopathy are becoming increasingly common, and this trend is expected to continue.
Myelopathy Symptoms
Symptoms of myelopathy in Minnesota often include clumsiness and gait disturbances such as stiffness, imbalance, unsteadiness, or changes in walking speed or rhythm. In one small study involving patients with cervical myelopathy, every participant reported gait changes as their earliest symptom.
Myelopathy can interfere with everyday activities, making routine tasks such as buttoning a shirt, holding a cup of coffee, or eating soup more difficult. Patients may experience loss of sensation in the arms, hands, or legs. Weakness in the legs, balance issues, dropping objects, reduced manual dexterity, difficulty writing, or trouble combing hair are also common symptoms.
Additional symptoms may include:
- Spasticity in the arms or legs
- Neck or shoulder pain
- Occasional bladder incontinence
- Blurred vision
- Tinnitus (ringing in the ears)
- Dysphagia (difficulty swallowing)
Because these symptoms are often vague or nonspecific, some patients are mistakenly told they are simply aging or experiencing stress. Balance and walking problems may be attributed to normal aging, while hand symptoms may be misdiagnosed as carpal tunnel syndrome. Failure to recognize these symptoms as signs of myelopathy can delay diagnosis by an average of six years.
Myelopathy Causes
There are many possible causes of myelopathy in Minnesota, including congenital conditions, degenerative disorders, injuries, infections, and other disease processes.
Congenital Causes of Myelopathy
Some congenital conditions, such as hypoplasia of the atlas (underdevelopment of the first cervical vertebra), may directly cause myelopathy or increase the risk of developing it. Some individuals are also born with unusually narrow spinal canals, a condition associated with spinal stenosis.
Degenerative Processes
Myelopathy may develop gradually with age. In some patients, symptoms progress rapidly and lead to disability within a short period. In others, symptoms worsen more slowly over many years.
For many individuals, the disease progresses unevenly, with periods of stability interrupted by symptom flare-ups. Minor trauma, such as a fall, may worsen symptoms. Even during periods without noticeable decline, however, the disease itself is not in remission. Following flare-ups, patients often return to a reduced level of functioning.
Spondylosis
Spondylosis is the most common cause of cervical myelopathy in Minnesota. For this reason, the condition is frequently called cervical spondylotic myelopathy (CSM).
Spondylosis involves several age-related spinal changes, including:
- Degenerative disc disease
- Collapse of the disc space
- Formation of bone spurs
- Calcification of ligaments and surrounding structures
These degenerative changes can increase the likelihood of spinal cord compression.
Herniated Disc
A herniated disc usually pushes disc material to the side of the spinal canal, where nerves enter and exit. In some cases, however, the disc herniates directly backward into the spinal canal, placing pressure on the spinal cord. This is known as a central disc herniation.
Spinal Stenosis
Spinal stenosis is a condition in which the spinal canal narrows or is naturally smaller than average. The typical spinal canal measures approximately 17 to 18 mm in diameter.
When the canal diameter measures less than 12 mm, there is significantly less space available for the spinal cord. As a result, degenerative changes may become symptomatic more quickly than they would in individuals with a normally sized spinal canal.
Acute Causes of Myelopathy
Injury
Traumatic injury to the spinal cord can lead to myelopathy in Minnesota patients and others alike. Falls and other spinal injuries may damage the spinal cord directly. Radiation treatment near the spinal cord may also compromise cord function.
Infection
Infections involving the spinal cord, including tuberculosis, may cause myelopathy. Cytomegalovirus infection associated with AIDS can also produce neurologic symptoms such as weakness, spasticity, and sensory loss.
Disease Processes
Several disease processes may contribute to spinal cord compression. Multiple sclerosis can impair walking and neurologic function. Autoimmune diseases such as rheumatoid arthritis may affect the spinal joints and bones, leading to spinal cord compression.
Other Causes of Myelopathy
Any abnormal growth or mass within the spinal canal may place pressure on the spinal cord. Examples include:
- Blood clots
- Tumors
- Cysts
- Osteophytes (bone spurs)
How Myelopathy Is Diagnosed
Early diagnosis of myelopathy in Minnesota is important because prompt treatment may reduce the risk of permanent disability and improve outcomes.
Diagnosing myelopathy can be challenging because symptoms are often vague and may appear unrelated. For example, urinary urgency or frequency may lead a patient to seek urologic evaluation before spinal cord compression is recognized.
To make an accurate diagnosis, your physician will gather information about your symptoms, including when walking difficulties began, whether symptoms are constant or intermittent, and the severity of pain. Your doctor will also review your medical history, lifestyle, and overall health.
Diagnostic imaging studies such as MRI scans are commonly used to identify spinal cord compression, spinal stenosis, spondylosis, disc degeneration, or herniated discs. Electromyography (EMG) may also be performed to rule out conditions that mimic myelopathy, including amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS).
Conservative Myelopathy Treatments
Treatment for myelopathy in Minnesota focuses on improving mobility, restoring fine motor function, reducing pain, and preventing progression of the disorder.
Non-Surgical Myelopathy Treatments
Your doctor will probably begin with conservative treatment options, such as:
- NSAIDs (nonsteroidal anti-inflammatory medications)
- Physical therapy
- Occupational therapy
- Use of a cervical collar or brace
For patients with mild symptoms or younger individuals, conservative care may help relieve pain and improve neurologic functioning enough to return to normal daily activities.
Myelopathy Surgery: What are Your Options?
Although conservative treatment may delay surgery, myelopathy is generally considered a progressive disorder. Research suggests that patients over age 60 and those with significant neurologic dysfunction often experience better outcomes with surgery than with nonsurgical treatment.
The surgical treatment for myelopathy in Minnesota is called spinal decompression surgery. Decompression surgery is commonly recommended for patients with severe disability or advanced spinal cord compression at the time of diagnosis.
Studies have shown that both younger and older patients can benefit significantly from decompression surgery. While older adults may have a slightly higher risk of complications, their likelihood of symptom relief and improved function remains high.
Minimally Invasive Myelopathy Surgery
Minimally invasive techniques for treating myelopathy in Minnesota generally result in lower complication rates than traditional open surgery.
Because minimally invasive spinal surgery requires smaller incisions and shorter operative times, patients may experience fewer anesthesia-related risks and shorter recovery periods. Even patients who smoke or those with obesity, who may not be ideal candidates for open procedures, may still qualify for minimally invasive spinal surgery.
Contact us Inspired Spine at (952) 225-5266 to speak to one of our Patient Care Coordinators.
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