Nearly 10% of adults will experience some form of severe neck pain in any given calendar year.* But some injuries or degenerative conditions of the neck (the cervical portion of the spine) don't necessarily cause neck pain but, rather, lead to sensations in other parts of the body. One such condition is cervical myelopathy.
Cervical myelopathy is a disease where patients can develop balance problems impeding walking, a loss in manual dexterity as well as problems with bowel and bladder function. These symptoms can be accompanied by numbness, tingling and/or weakness in the arms and/or hands. It has an insidious course where patients can plateau in their symptoms, but overall, it is a progressive condition.
Cervical myelopathy can be caused by a number of conditions that result from spinal cord compression. Some relatively common causes are severe osteoarthritis of the cervical spine (cervical spondylotic myelopathy – CSM) and ossification of the posterior longitudinal ligament (OPLL).
Usually patients with cervical myelopathy will present with balance and coordination problems making walking difficult and with manual dexterity problems (such as difficulty to button shirts). In some cases, patients can also develop problems with bowel and bladder function. These symptoms can also be accompanied by numbness, tingling or weakness in the upper extremities.
The common treatments for cervical myelopathy include surgical and non-surgical options. Nonsurgical options include the use of oral corticosteroid therapy. This can result in a transient improvement in the symptoms of cervical myelopathy. Definitive treatment of cervical myelopathy is a decompression of the spinal cord via an anterior and/or posterior approach. The decision to have surgery via the different approaches will depend on where the compression of your spinal cord is as well as the overall alignment of the cervical spine and finally, patient factors. This will be determined by your surgeon.
Recent research into the use of the medication Riluzole on patients with myelopathy may be promising. This drug might help the spinal cord recover from the injury it has sustained from being compressed and might be useful as a medication to help the spinal cord recover after surgery to decompress the spinal cord. Further research is necessary to demonstrate its efficacy in humans, but preliminary animal studies have been promising.
Dr. Han Jo Kim is an Orthopedic Surgeon at Hospital for Special Surgery, specializing in Cervical Spine and Scoliosis Surgery. As the Co-director of Research and Education for the Scoliosis Service, he is a lead investigator for numerous research studies and has won multiple awards in the national and international arena. Dr. Kim has also volunteered time as a surgeon at the FOCOS hospital in Ghana, West Africa where he has successful operated on over 50 rare and complex spinal deformities.