What is cervical myelopathy?
Compression of the spinal cord in the neck leads to dysfunction of the spinal cord and nerves distal (beyond) the site of compression. The clinical condition is called cervical myelopathy.
What is the aetiology (cause) of cervical myelopathy?
The most common cause is cervical spondylosis (degenerative changes in the spine)
In this condition the degenerated disc with an osteophyte (new bone growth) compresses the spinal cord. The other rare causes are tumors, infection.
 |
|
Normal Cervical Spine |
Degenerated Cervical Spine |
Figure a – cross section of the normal cervical vertebra and spinal cord.
Figure b – cervical spondylosis; Red arrows point to the disc osteophyte complex
compressing and thinning the spinal cord.
What are the symptoms of cervical myelopathy?
The most common symptoms are numbness of the hands and feet, loss of manual dexterity (difficulty in buttoning clothes, writing, combing hair), imbalance and awkward gait. In the early stages the patient is able to carry out his / her normal activity. If left untreated the condition may progress leading to severe disability. Occasionally the bowel and bladder function may be disturbed.
How is it diagnosed?
Usually the symptoms of a patient and a complete clinical examination are enough to help the doctor identify the problem.
However, other diseases of the spine like infection, tumour and fracture can also present with similar symptoms.
To rule out other conditions, various blood tests, X-rays, CT scan or MRI scans are advised. MRI scan is the imaging modality of choice. (See figure c)
Figure c – Multi-level disc protrusion causing spinal canal stenosis (narrowing) and spinal cord compression.
What is the treatment?
In the early stages neurotropic (nerve vitamins) medication and symptomatic treatment may suffice, but regular follow up with your doctor is advised to detect progression / deterioration of the neurological condition necessitating surgical intervention.
In the presence of significant neurological deficits or progression of deficits surgery to decompress (remove compression on) the spinal cord is advised at the earliest. Optimal results are achieved in young patients with mild neurological symptoms and deficits.
What are the surgical options?
The goal of surgery is to remove the compression on the spinal cord. This may be achieved by surgery from the front or the back of the neck.
The surgeon will decide on the type of surgery best suited for you after taking many factors in to consideration. Some of the factors are (1) number of levels of compression, (2) the cause of compression, disc or thickened ligaments, (3) curvature of the spine.
The various options are
- Cervical discectomy and fusion (link)
- Cervical disc replacement (link)
- Cervical laminectomy
- Cervical laminoplasty
What is cervical laminoplasty?
When the spinal canal has become too small due to injury or disease, it may be made larger by use of laminaplasty. By increasing the space for the spinal cord and nerve roots, laminaplasty reduces the spinal cord compression and may help prevent progression of neurological deficits. It preserves the stability of the neck.
The lamina is a flat portion of bone that is the back portion of the vertebra. On one side of the vertebral column, the laminas are cut through just far enough to create a hinge-like movement, much like a door. Then the lamina on the other side are cut all the way through to, in effect, open the door. After gently opening the "door" of each vertebra to create more room for the spinal cord and nerve roots behind it, bone wedges are inserted to keep the "door" from totally closing. Then the "door" is closed securely onto bony wedges, resulting in an expanded "doorway" for the spinal cord and nerves.
CT Scan of open door cervical laminoplasty
What is a cervical laminectomy?
When the spinal canal has become too small due to injury or disease, it may be made larger by use of laminectomy. By increasing the space for the spinal cord and nerve roots, laminectomy reduces the spinal cord compression and may help prevent progression of neurological deficits.
An incision is made down the back of the neck to expose the cervical vertebrae. Then the laminas are cut all the way through on either side of its attachment to the vertebra. The lamina with the intervening ligaments is excised (removed) creating more room for the spinal cord and nerve roots.
Adequate decompression following cervical laminectomy
This information is provided by Ganga hospital and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the hospital (0422-2485000) to book an appointment to see a doctor. This document was last reviewed on: 1/05/2008
|
