Cervical Myelopathy

Cervical spine anatomy

The cervical spine provides mobility and stability to the head and neck and protects the spinal cord. It is composed of seven stacked vertebrae, C1 through C7 with cartilage cushions in between, called intervertebral discs, and ligaments and tendons.

C stands for cervical. At the top of the cervical spine is C1, called the atlas, which connects the head to the neck and supports the head, while C2 is called the axis because it provides range of motion for head and neck movements. C7 connects the bottom of the neck to the upper back. C3 through C7 support the head and neck and connect the cervical spine with the thoracic spine.

Holes in the vertebrae create a passage for blood vessels that bring blood to the brain and openings for spinal nerve roots to supply nerves to other parts of the body. Neck muscles support the cervical spine and contribute to range of motion.

Cervical myelopathy is spinal cord dysfunction due to compression of the spinal cord in the neck. Due to neck mobility, the vertebral column in the neck is particularly prone to degenerative changes including disc herniation, ligament calcification and bone spur formation.

Degenerative cervical myelopathy is a progressive disease and the leading cause of spinal cord injury in adults worldwide. It usually affects people over age 50, and can result in major nervous system (neurologic) disability and reduced quality of life.

The most common symptoms of myelopathy are weakness and clumsiness of the hands and difficulty with balance and walking. Some people have no symptoms in the early stages of the disease. Some have subtle symptoms that can delay diagnosis which is the reason to see a neurologist for diagnosis.  Left untreated cervical myelopathy can lead to neurological decline and paralysis.  Studies have shown that early diagnosis and surgical management may improve outcomes and prevent progressive deterioration.

Cervical spine myelopathy occurs when age-related osteoarthritic changes cause cervical spinal stenosis, a narrowing of the cervical spinal canal leading to cord compression and disability. Other age-related changes that cause cord compression include disc herniation or bulging discs; and ligament hardening causing bulging into the canal. Other causes include Rheumatoid arthritis, spinal fractures, and injuries to the neck.

Most patients describe symptoms as ongoing for months and worsening. How quickly it progresses varies. Patients may regard symptoms as just getting older.

Symptoms include:

  • Neck pain, weakness, and stiffness
  • Arm, shoulder and hand pain
  • Muscle weakness, numbness
  • Loss of fine motor skills including difficulty grasping, holding, writing, buttoning, picking up coins and using fingers
  • Leg stiffness, weakness and sensory loss
  • Sensations of tingling or pins and needles in the hands, arms and fingers
  • Imbalance when standing or walking
  • Poor coordination including loss of balance and falls
  • Trouble using fine motor skills, such as writing
  • Bowel and bladder issues

Your Dallas Neurosurgical & Spine specialist will review your medical history and ask about your symptoms. They will conduct a comprehensive neurological examination and physical examination of your neck and shoulders, arms, hands and legs testing reflexes, looking for numbness and weakness, difficulty walking and balance. They will also look for muscle deterioration.

Sometimes symptoms of cervical spine stenosis are misdiagnosed as carpal tunnel radiculopathy (a pinched nerve). Thus, a comprehensive neurological evaluation is essential to identify the source of the symptoms. In some cases, cervical myelopathy can be painless despite progressive neurological symptoms. For this reason, it is sometimes diagnosed late in the course once falling or coordination has become unmanageable.

Your specialist may order a cervical spine MRI to view the soft tissues to reveal spinal cord compression and damage to the intervertebral discs. A CT scan may be ordered to reveal cord compression and bone spurs. Sometimes an imaging study called a CT Myelogram will be ordered which involves injection of a contrast dye into the spinal cord to the cord and nerves.

At Dallas Neurosurgical & Spine, our neurosurgeons treat a variety of neurological and spinal conditions and see nearly 6,000 patients each year. In addition to being the longest-established private neurosurgical practice in North Texas, Dallas Neurosurgical & Spine offers superior patient services including state of the art diagnosis, treatment, procedures, and equipment.

Contact us to schedule a consultation today. Early diagnosis and treatment can help restore and maintain function.

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