Cervical Myelopathy (spinal cord compression)

Cervical myelopathy means pathology (disease condition) of the cervical spinal cord. The cervical spinal cord includes the first 7 vertebrae of the spinal cord, beginning at the base of the neck. Cervical myelopathy may be caused by a trauma, degenerative disc disease, or other condition which causes the spinal canal and spinal cord within to become squeezed. Compression of the cervical spinal cord may cause neck pain, back pain, and a host of neurologic symptoms related to the nerves of the spinal cord being compacted.

As we get older, degenerative changes to the bones of the vertebral column may cause the bones to wear out at their edges, and then to repair themselves with new layers of bone. These new layers and growths of bone may cause the bones to become thicker than they were before. This thickening of vertebrae may cause the vertebral canal, that houses the spinal cord, to become smaller in diameter. When the canal loses its size, the result may be cervical myelopathy. Other degenerative changes may also cause cervical myelopathy, such as herniated discs and arthritis to the joints of the spine.

Cervical myelopathy (spinal cord compression) is the result of spinal stenosis. Spinal stenosis is a reduction in the size of the vertebral foramen, which is the cavity that lies within the vertebral arch. The spinal canal, which houses the meninges that protect the spinal cord, travels the length of the spine, from the base of the brain, until about the level of L1-L2 in the lumbar spine. The meninges are three layers within the spinal canal that protect the nerves of the spinal cord and provide the spinal cord with oxygen, nutrients, and channels for removing carbon dioxide and metabolic wastes. The spinal canal extends through the spine, between the vertebral foramen and the ligaments that extend the length of the spine. Between the each vertebra, the spinal canal is protected anteriorly by the posterior longitudinal ligament, and posteriorly by the ligamentum flavum. Arthritic and disease related changes to the spine may cause these structures to become pressed together, resulting in various neuropathic symptom associated with the nerves within the spinal cord, and the nerve roots that supply the head, neck, and upper extremities.

Cervical myelopathy may be cause by an:
  • An accident or trauma.
  • An inflammatory disease or inflammatory reaction to an injury in or around the cervical spinal cord.
  • A vascular disease, such as vascular myelopathy.
When any of these three type of disease conditions causes the narrowing of the spine, the nerves of the spinal cord and the nerve roots that exit at each level may become pinched, or compressed. The symptoms that we experience as a result of this nerve compression may include neck pain, upper back pain, and numbness and weakness in our upper torso and arms. Cervical spinal stenosis and cervical myelopathy may affect people of all ages, but it is more common with the elderly.

Symptoms associated with this condition include:
  • Upper extremity (shoulder and arm) pain. Pain that affects the neck and arm simultaneously is called cervical radiculopathy.
  • Sporadic shooting pain in the arms and legs, like an electric shock, that are often triggered then flexing the head and neck forward. This shock like symptom is known as Lermitte's phenomenon when flexion of the neck triggers these types of symptoms.
  • Difficulty with fine motor movements and ability of the arms and hands (such as drawing, writing, and typing)
  • Difficulty with ambulation (running and walking at a quick pace)
  • A feeling of heaviness in the legs