Myelopathy

Myelopathy is a term used for compression of the spinal cord. Therefore, this can occur anywhere between the top of the neck and bottom of the thoracic spine. The spinal cord serves as the pathway of nerve transmission from the brain to the body. It sits behind the vertebrae and the discs in a channel called the spinal canal. At each level in the spine two nerves branch off from the spinal cord to each side of the spine, to the arms, around the chest or to either leg. Symptoms of spinal cord compression or myelopathy are varied. If it occurs in the neck then it can cause pins and needles in the upper limbs, loss of dexterity as well as weakness in the hands and problems with the legs with regards to balance and co-ordination, loss of bladder and bowel function is rare initially. The condition tends to be painless unless there is associated nerve root compression and if so, there will be a radiating nerve pain associated with it.
Causes of a myelopathy include herniated disc or bone spur related to disc degermation. Other causes include spinal tumours, infection or abscess, trauma as well as spinal deformity.
The usual time course for symptoms arising from spinal cord compression are that of a gradual onset and slow progression. This is more common in the older age group but can be of an accelerated origin depending on the cause.
Treatment of myelopathy depends on the individual’s symptoms and signs. If a patient is functioning well then conservative treatment can be followed but if there is a progression in the symptoms, then surgery may be recommended to relieve the spinal cord compression and to halt the progress of spinal cord dysfunction.
The individual treatment will be based on the individual course and certainly physical therapy and observation over time can be recommended in mild cases and if surgery is advised then this may involve either surgery from the front or the back of the neck and sometimes a combination of both approaches.
Anterior surgery involves either removal of the disc or removal of the vertebral body (corpectomy). These procedures would either involve a fusion or disc replacement for a discectomy and/or an expandable implant with a plate for corpectomy.
Posterior decompressive surgery involves removal of part of or the whole lamina and this can be combined with fusion with screws and rods as necessary. The goal is to expand the spinal canal and occasionally this can be done without removal of the whole lamina through a procedure called laminoplasty.
Again, minimally invasive options can be used, and these will be discussed at the time of clinic attendance.