Myelopathy
Myelopathy refers to a compressive injury usually resulting from trauma, disc prolapse or degeneration. This may result in progressive hand numbness, loss of dexterity, gait instability or urinary dysfunction.
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What is Myelopathy?
Myelopathy describes a collection of symptoms that result from severe spinal compression. When the spinal cord is compressed, it cannot function properly. That can result in to pain, numbness and/or limited mobility in some parts of the body.
Being a compressive injury that is usually caused by trauma, disc prolapse or degeneration, myelopathy may result in progressive hand numbness, loss of dexterity, gait instability or urinary dysfunction.
Early decompressive surgery will result in a better outcome and prevention of permanent disability. In multi-level degenerative cervical myelopathy, posterior decompression and fusion is a safe and commonly performed surgical procedure.
Myelomalacia is a radiographical finding on magnetic resonance imaging and is represented as a high intensity signal on T2-weight images. It is typically better visualised after decompression surgery.
There are three different types of myelopathy — cervical, thoracic and lumbar. They are classified according to their location of the spinal compression.
Types of Myelopathy
Cervical spondylotic myelopathy
refers to when the patient’s compression occurs mainly in the cervical spine. This is the neck region that consists of seven bones (C1-C7 vertebrae).
Thoracic myelopathy
develops in the middle area of the spine. The thoracic spine is in your mid and upper back and consists of twelve vertebrae numbered T-1 to T-12
Frequently Asked Questions
What are the symptoms?
Spinal cord compression affects the nerves that control many of your body’s movements and functions. Myelopathy can affect different areas of the spinal cord and the symptoms can vary depending on which part is impacted.
Common symptoms include:
- Pain in your neck or back.
- Tingling, numbness or weakness in your arms, hands or feet.
- Balance or coordination issues.
- Loss of bladder or bowel control.
What are my treatment options?
Treatment for myelopathy depends on what is causing the myelopathy as it can be an infection or a tumour in which case, the priority will be to treat the tumour.
Non-surgical treatments can help relieve symptoms for some cases but spinal cord compression usually requires surgery in order to relieve the pressure.
How is it diagnosed?
The most common symptoms of myelopathy are often mistaken for other disorders as they are not unique to the condition.
Therefore, to ensure an accurate diagnosis, your doctor may perform a thorough physical exam in addition to imaging tests.
These tests may include:
- A spine X-ray, MRI or CT scan.
- A Myelogram that uses contrast dye along with X-rays or CT scans help differentiate between the bones and soft tissue in your spine.
- Nerve function tests that can measure how your brain and body transmit signals.
Targeted Procedures
ACDF
An ACDF is done with an anterior approach, this means that the surgery is done through the front of the neck and not through the back of the neck. This approach has several typical benefits which includes allowing the surgeon direct access to the disc and less post-operative pain.
Laminectomy
This procedure is performed through an incision on the lower back. The surgeon removes a section of bone, called the lamina, from one or more vertebrae. This relieves pressure on the nerve roots caused by stenosis (narrowing of the spinal canal).
The steps usually involve:
- 1) Removing the spinous process: First the surgeon removes the spinous process (the back portion of the vertebrae that protrudes furthest from the back of the spine). These are the bones that you feel when you touch the middle portion of your lower back.
- 2) Removing the Lamina: the surgeon removes the lamina (the portion of the vertebra that covers the nerve roots). Removing the damaged the lamina opens up the spinal canal, taking pressure off the nerves.
- 3) Clearing bone fragments: There may have some remnant fragments that pinch the nerve roots as they exit the spinal canal in the nerve foramina.
Spinal Fusion
Why choose spinal fusion?
Spinal fusion is a type of spine surgery performed to promote stability at a diseased motion segment. This usually involves removal of the lamina (portion of the vertebrae that covers the spinal cord). Removing the lamina relieves pain and pressure. Subsequently, screws and rods are inserted. Bone grafts are added to the sides of the spine. The grafted bone will then fuse to the spine.
Is it suitable for me?
You may be a candidate for spinal fusion if you have signs and symptoms of spinal instability. These may include pain, weakness or numbness of the hands and feet.
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