What is Cervical Myelopathy?
A progressive condition in which the spinal cord is compressed within the cervical canal, disrupting the signals running through it. Damage to the cord is irreversible, so the priority is to take pressure off the cord and prevent further deterioration.
Causes
Cervical canal stenosis (age-related narrowing of the bony tunnel); bone spurs (osteophytes) from arthritis projecting into the canal; thickened ligaments at the back of the canal; ossification of the posterior longitudinal ligament (OPLL); multilevel disc degeneration; and, less commonly, large central disc herniations.
Symptoms
Clumsy hands and difficulty with fine motor tasks (buttoning shirts, handling coins); loss of grip strength or dropping things; pins and needles or numbness in the arms, hands or legs; an unsteady walk and balance problems; generalised weakness in the arms or legs; in severe cases, changes in bowel or bladder control.
Diagnosis
History focused on hand function, balance, gait and bowel/bladder symptoms. Examination reveals upper motor neuron signs including increased tone, brisk reflexes, clonus, and an unsteady gait, with the corresponding sensory and motor changes.
Imaging
MRI is the investigation of choice — showing the spinal cord, the degree and pattern of compression, and any signal change within the cord itself. CT is helpful for cases of OPLL or when detailed bony anatomy is relevant. X-ray for alignment and stability.
Treatment
Cord damage is irreversible, so the priority is surgical decompression to prevent further deterioration. Many patients also notice meaningful improvement in symptoms — but this cannot be guaranteed, and the longer the cord has been compressed, the harder it is to fully recover. The choice between anterior (ACDF or cervical disc replacement) and posterior (laminoplasty or laminectomy with fusion) approaches depends on the level and pattern of compression, neck alignment, and the number of levels involved.