What is Cervical Myelopathy?
Cervical myelopathy means the spinal cord in the neck is being squeezed. It is most often caused by advanced cervical spondylosis — a combination of bulging discs, bone spurs and thickened ligaments narrowing the canal the cord runs through.
Unlike ordinary neck pain, this is a condition of the spinal cord itself, and cord damage does not fully recover once established. That is why it is one of the few spine problems where doctors recommend surgery early rather than as a last resort.
Because it starts slowly and neck pain may be mild or absent, it is frequently missed. Many patients are treated for months for “weakness” or “old age” before the neck is examined.
Warning Signs
The symptoms come from the cord, so they affect the hands and legs more than the neck:
- Clumsy hands: difficulty buttoning a shirt, writing, or holding a cup
- Numbness or tingling in both hands
- Unsteady, stiff or “wobbly” walking; needing to hold walls or a stick
- Weakness in the legs, frequent tripping or falls
- Electric-shock sensation down the spine on bending the neck
- In advanced cases, urgency or difficulty controlling urine
Causes
The cervical canal can be narrowed by: degenerative changes of spondylosis (the commonest cause in patients over 50); a large central disc herniation; ossification of the posterior longitudinal ligament (OPLL), which is relatively common in Asian populations; a congenitally narrow canal; rheumatoid arthritis affecting the upper neck; or, rarely, tumours and infections such as spine TB.
Diagnosis is by clinical examination (brisk reflexes, characteristic hand and gait signs) and an MRI of the cervical spine, which shows the degree of cord compression and any signal change within the cord.
Treatment
Mild, Non-Progressive Cases
A small group of patients with mild symptoms that are not changing can be observed closely, with:
- Regular neurological check-ups every 3–6 months
- Avoiding activities that jerk or hyper-extend the neck
- Gentle physiotherapy for balance and hand function
Any worsening — even slight — is a reason to move to surgery. Neck manipulation and traction should be avoided.
Surgery: the Definitive Treatment
For moderate or progressive myelopathy, surgery to decompress the spinal cord is the treatment of choice, and results are best when done before the cord is severely damaged. Depending on the levels involved and the shape of the neck, Dr Batra performs:
- Anterior surgery — ACDF or corpectomy with cage and plate, removing the compression from the front
- Posterior surgery — laminoplasty or laminectomy with fixation for multi-level compression
- Combined front-and-back surgery for severe deformity
The aim is to stop further loss of function; most patients also regain a good part of what was lost, especially hand function and walking. Several of the patient stories on this site — bedridden patients walking again after cervical surgery — are cases of myelopathy treated in time.