Myelopathy (pressure on the spinal cord)

 

Condition  

 This means ‘disease of the spinal cord’ which is often caused by pressure.  There are, however, medical conditions which can cause this. It is a symptom and does not describe the underlying problem.  The pressure is usually caused by a slipped disc or other degenerative changes of the bones and ligaments. It can also be caused by infection, tumours or fractures of the spine. Myelopathy can affect the spinal cord at any level but is most common in the neck. It is rare in the thoracic spine.

Symptoms    

Pressure on the spinal cord can cause different symptoms. Often, the hands feel clumsy or stiff and patients find it difficult to undo buttons or write. The legs might feel stiff and patients might have frequent falls. Sometimes, spontaneous jerking of the legs can occur. If the pressure continues or increases, the arms and legs become weak. The condition itself usually does not produce pain although patients might have neck pain due to the underlying wear and tear. The symptoms can be very subtle at the beginning and very slowly progressive but can also rapidly occur.

Complications     

Myelopathy is a potentially very disabling condition depending on the severity of the pressure. Permanent problems (stiffness and weakness) of hands and legs are common.

Investigations

All patients with signs of myeleopathy should be investigated as soon as possible. An MRI scan is usually the investigation of choice. Plain x-rays in flexion and extension might also be useful in addition if instability is suspected.

Treatment and Outlook    

The main aim is usually to prevent deterioration rather than hoping for a significant improvement. This is the main reason why patients should be investigated and treated before they have developed serious disabilities from this. In degenerative disease surgery is usually treatment of choice in the form of an anterior cervical discectomy, corpectomy, laminectomy or laminoplasty. In tumours radiotherapy or chemotherapy with or without surgery might be indicated.  In a number of cases, the symptoms continue to deteriorate due to the damage that has been done. The spinal cord often does not recover or take a very long time to improve.

 

Compression of the spinal cord at multiple=

Compression of the spinal cord at multiple levels