Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy is one of the most common conditions that causes spinal cord dysfunction. Most common in people over 50, it is caused by degeneration to the discs and joints of the neck which results in the spinal cord being narrowed and compressed. This process usually happens because of arthritis in the neck which may be caused by several factors although the reasons are not yet completely understood. The condition may also occur in younger patients if they have previously suffered an injury to the neck area.

Cervical spondylotic myelopathy presents with symptoms including numbness, pain and weakness in the neck. Following the onset of symptoms, typically the condition worsens slowly over a period of years although in a small percentage of cases, progression is more rapid.

Causes of cervical spondylotic myelopathy include rheumatoid arthritis which makes the neck stiff and painful as joints in the area are destroyed. Another cause of pain in the neck is degeneration of the cervical disc which causes stress, wear and tear to the neck joints as the disc space narrows. Neck injuries are also another common cause of the condition. Trauma to the neck is surprisingly common from accidents while driving, falling or during contact sports. Other causes include tumours, birth defects in the vertebrae or infections.

The main symptoms of cervical spondylotic myelopathy are pain and stiffness in the neck together with tingling, numbness and weakness. The patient may have difficulty in picking up objects or have trouble walking due to loss of balance. They may also find that they suffer from a lack of co-ordination which makes writing, dressing and eating difficult.

A doctor can diagnose the condition by carrying out a neck examination. They will also test for numbness and weakness in the limbs as well as muscle atrophy and abnormal reflexes. It is possible that x rays, MRI scans or a Myelogram may be necessary to correctly diagnose the condition.

Most patients will be treated with non-surgical options. These include the use of soft collars designed to allow the muscles of the neck to be supported and limit the movement of the neck. This solution is not intended for long term wear as it can cause further deterioration to the muscle condition of the neck. The patient may be taught simple neck exercises to improve the tone of the muscles and increase flexibility or chiropractic manipulation may be recommended. Patients may also be prescribed NSAID drugs such as Ibuprofen to help reduce swelling and pain. Rarely, patients may receive cortisone epidural injections.

There are surgical options which may be recommended to some patients. Surgery may be suitable for those who have severe or extremely progressive symptoms. An operation can be performed to decompress the spinal cord either from the front or back of the neck to remove the discs or bones that are pressing on the spinal cord. Fusion of some of the vertebrae will then be carried out to increase stability although flexibility of the neck will be decreased following the procedure.