Myelopathy

Myelopathy is a neurologic condition caused by spinal cord compression. It can lead to a large number of symptoms including neck or back pain, poor balance, numbness, weakness, trouble using the hands, and loss of bladder or bowel control.

Myelopathy results from spinal cord compression usually due to a disc herniation or bone spurs. An ossified posterior longitudinal ligament or a tumor may also compress the spinal cord. Cord compression usually occurs in the cervical spine but may occasionally occur in the thoracic spine.

Myelopathy is usually diagnosed on physical exam in combination with MRI. It is a serious condition that is almost always progressive; it is generally best treated with surgery. Myelopathy should be treated surgically if the patient is of reasonable enough health to tolerate an operation. Non-operative treatments such as therapy, medicines, and injections do not relieve spinal cord compression.

Without surgical intervention, all myelopathies worsen. It usually progresses slowly, but some causes of myelopathy such as acute disc herniations can produce severe, sudden deterioration in function. The prognosis for recovery after surgery depends on the cause of the myelopathy as well as the stage of the myelopathy, including whether the patient is walking independently, walking with an aid, or wheelchair-bound. After surgery, 70% of patients see improvement in symptoms (sometimes complete), 15% of patients see no further deterioration but no improvement, and 15% of patients continue to decline despite surgery. Those patients who continue to decline usually present with more severe symptoms prior to surgery. 100% of patients decline without surgery.

The approach to relieving spinal cord compression can be either from the front, or anterior, approach or from the back, the posterior approach. Both approaches can be successful; the choice of approach typically depends upon which direction the spinal cord is being compressed. Usually, an anterior approach is chosen for anterior compression of the cord and a posterior approach for posterior compression.