Myelopathy is the result of a condition that compresses the spinal cord and affects nerve functions. Myelopathy disrupts the transmission of nerve signals between the brain and other body parts.

Myelopathy is sometimes confused with myopathy, but the two are distinct conditions that affect different body parts. While myelopathy affects the nerves in the spinal cord, myopathy affects your muscles.

Myelopathy can relate to three areas:

1. Cervical myelopathy, a compression of the spinal cord in the neck, which affects the nerves in the neck and the function of the hands and arms.
2. Thoracic myelopathy affects the middle and upper back.
3. Lumbar myelopathy relates to a compression of the spinal cord in the low back.

Myelopathy is caused by spinal cord compression which often may be caused by arthritis, spondylosis, a bone spur or stenosis.

Myelopathy can cause the vertebrae to slowly degenerate. When the neck area is affected, the resulting condition is called cervical spondylotic myelopathy. This can damage the nerves of the spinal cord and block nerve impulses control your arms, legs, and other body parts. This leads to weakness and pain.

Symptoms of Myelopathy

• Pain or a loss of sensation or function in the arm or leg
• Pain in your neck, arms, legs, and lower back
• Difficulty coordinating body movements
• Numbness or weakness in an arm or leg
• Difficulty with writing or tying your shoelaces
• Loss of bowel or bladder control

Myelopathy is diagnosed with several diagnostic tests including: X-ray, MRI or myelography which involves injecting a dye to detect problems with the spinal cord.

Treatment of myelopathy

• Non-surgical treatment options for myelopathy can include a brace that is intended to reduce pressure on the spinal cord. While it’s not a cure, bracing may prevent the condition from worsening.
• Physical therapy exercises may also relieve pressure on the spinal cord.
• Non-steroidal anti-inflammatory drugs can reduce pain and other symptoms. Spinal injections can inject steroids directly into the affected area to ease the pain.

Often surgery is needed to relieve the pressure on the spinal cord and prevent a progression to paralysis of nerves and loss of bladder or bowel control. Surgery is the only way to remove tumors and bone spurs that may be the cause of myelopathy. Spine surgery is usually the only permanent way to relieve the compression on the spinal cord and enhances quality of life and worsening of the myelopathy.

Spine surgery to treat myelopathy

• Laminectomy which removes the lamina and bone spurs in the spinal canal to relieve the spinal cord compression.
• Laminoplasty which involves removing the lamina on one side and cutting it away completely from the other side, creating a hinge that creates space for the spinal cord to expand to its original position. This is only done on spinal bones in the neck.
• Spinal fusion which involves fusing two or more vertebrae to form a single bone, stabilizing the spine for pain relief.

Myelopathy vs Radiculapathy

There is a difference between the symptoms of myelopathy and radiculapathy. Myelopathy is a very serious condition and can quickly lead more directly to paralysis of the nerves in the hands and feet. For example, symptoms of cervical myelopathy include weakness, problems moving small objects with the hands, difficulty walking normally and fine motor skills like writing or tying shoes.

Conversely radicular and radiating pain and numbness is a common symptom of a herniated disc. A herniated disc in the neck can cause radiating pain/numbness/weakness in the arm and hand, while a herniated disc in the low back can cause radiating pain/numbness/weakness in the leg and foot. While a person can use watchful waiting for a month or so for radiating pain, that is NOT the case with numbness or weakness in an arm or leg. That can lead to permanent paralysis of the nerves in the arm or leg. Consequently, numbness or weakness needs to be seen by a spine surgeon within a few days to prevent permanent problems.

A simple test for cervical myelopathy can include 10-second grip-and-release test to find the presence of myelopathy in the hand. This test evaluates the number of repetitive grip–release–grip motion cycles in a 10-second period (over 20 motion cycles is thought to be normal).