man with low back pain

Your spinal cord is an important part of your central nervous system. Made up of a group of nerves, it runs from the base of your brain to your lower back. It is key in helping your brain communicate with the rest of your body.

Different factors, from trauma to degenerative diseases, can compress your spinal cord. This condition, known as myelopathy, causes pain and numbness and makes it hard to perform daily tasks.

What Is Myelopathy?

Myelopathy refers to a nerve injury in your spinal cord caused by compression of the spinal cord. This compression can happen over time (chronic myelopathy) or suddenly (acute myelopathy).

There are three main types of myelopathy. The location of the spinal compression determines the type.

  • Cervical myelopathy: Compression in the neck (your cervical spine) is the most common form of myelopathy.
  • Thoracic myelopathy: Compression in the middle area of the spine (your back).
  • Lumbar myelopathy: Compression in the lower area of the spine (your lower back).

What Causes Myelopathy?

Myelopathy is the result of spinal cord compression. Factors that can cause this include:

  • Bone spurs.
  • Herniated disc.
  • Rheumatoid arthritis.
  • Spinal stenosis.
  • Trauma.
  • Infection.
  • Spinal tumors.
  • Other neurological degenerative diseases, including Parkinson’s disease and amyotrophic lateral sclerosis (ALS).

Because degenerative conditions can cause myelopathy, it is more common in older adults. People with underlying health conditions, including some cancers, are also at risk, as are those who take part in activities that can cause trauma.

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Symptoms of Myelopathy

Depending on the cause of your myelopathy, symptoms may occur quickly or develop over time.

Symptoms vary depending on the type of myelopathy. Because myelopathy affects your spinal cord, you may experience pain or weakness or have trouble with normal activities.

Common symptoms of myelopathy include:

  • Pain in the arms, legs, lower back, or neck.
  • Muscle weakness.
  • Tingling or numbness in the extremities.
  • Difficulty grasping or holding on to objects.
  • Balance problems or difficulty walking.
  • Motor skill problems, such as handwriting.
  • Bowel or bladder problems.
  • Sexual dysfunction.
  • Abnormal reflexes.

If you experience any of these symptoms, call your health care provider — especially if they don’t go away quickly.

How Is Myelopathy Diagnosed?

A visit to your health care provider begins with questions about your medical history and your symptoms.

A physical examination also is done to check your reflexes, muscle strength, and more.

Certain imaging tests may be needed for a final diagnosis, including:

  • X-rays
  • MRIs
  • CT scans
  • Myelograms
  • Nerve tests (electromyogram, or EMG).

A myelogram is a specialized imaging test that uses x-rays and the injection of contrast material to view the spinal canal. An EMG tests the nerves of the spinal cord to determine any problems.

Treatment for Myelopathy

Depending on the severity of your symptoms, treatment for myelopathy involves both surgical and nonsurgical options.

Nonsurgical treatment for myelopathy

Nonsurgical treatments include bracing the affected area, such as with a neck brace. Physical therapy and medicine also are options.

Medicines for myelopathy include:

  • Aspirin and ibuprofen (nonsteroidal anti-inflammatory medicines).
  • Corticosteroids.
  • Epidural steroidal injections.
  • Narcotics, in severe cases.

Surgery for myelopathy

If nonsurgical treatments don’t help, your doctor may recommend surgery.

There are several different surgical treatment options, depending on where the spinal compression is located. All surgical procedures aim to relieve the pressure on the spinal cord that is causing symptoms. Th specific cause of spinal compression — like a herniated disc, bone spurs, or a tumor — can be removed surgically.

Possible surgeries for myelopathy include:

  • Spinal fusion: This procedure connects two or more vertebrae in your spine to stabilize it. Doctors use a bone graft along with metal plates, rods, and screws to help make the connection. The goal is to relieve pressure by making your spine stable. This
    procedure is not usually necessary for patients experiencing thoracic or lumbar
    spinal stenosis unless it is associated with instability.
  • Laminectomy: This procedure involves removing some or all of the lamina, a bony arch in the back of your vertebrae. Doctors also can remove anything else that may be compressing the spinal cord, such as bone spurs. A laminectomy can allow more space for the spinal cord to move backward in the spinal column and may relieve pressure. It also makes it less stable, so spinal fusion may be necessary.
  • Laminoplasty: Like a laminectomy, this procedure aims to create more room for your spinal cord in the spinal canal. But instead of removing the lamina entirely, in a laminoplasty, doctors thin the lamina on one side and cut it on the other side to create a hinge. This works almost like a door — it allows your spinal cord to move more freely but preserves some stability.

Through a mixture of surgical and nonsurgical treatments, many symptoms of myelopathy can be reduced or cured.

At UPMC Orthopaedic Care, we diagnose and treat a wide variety of spinal conditions, including myelopathy. For more information or to schedule an appointment, call 1-866-987-6784 between 7 a.m. and 7 p.m., Monday through Friday.

Sources

American Academy of Orthopaedic Surgeons, Cervical Spondylotic Myelopathy (Spinal Cord Compression). Link

American Academy of Orthopaedic Surgeons, Cervical Spondylotic Myelopathy: Surgical Treatment Options. Link

Samuel K. Cho, MD, Jun S. Kim, MD, Samuel C. Overley, MD; Robert K. Merrill, MD, Journal of the American Academy of Orthopaedic Surgeons, Cervical Laminoplasty: Indications, Surgical Considerations, and Clinical Outcomes. Link

Shawn F. Kane, MD, Katarina V. Abadie, MD, Adam Willson, MD, American Family Physician, Degenerative Cervical Myelopathy: Recognition and Management. Link

About UPMC Orthopaedic Care

When you are dealing with bone, muscle, or joint pain, it can affect your daily life. UPMC Orthopaedic Care can help. As a national leader in advanced orthopaedic care, we diagnose and treat a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. We provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. Our multidisciplinary team of experts will work with you to develop the treatment plan that works best for you. Our care team uses the most innovative tools and techniques to provide better outcomes. We also are leaders in research and clinical trials, striving to find better ways to provide our patients care. With locations throughout our communities, you can find a provider near you.