Myelopathy | Johns Hopkins Medicine

What is myelopathy?

Myelopathy is an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation. The spinal cord is a group of nerves housed inside the spine that runs almost its entire length. When any portion of the spinal cord becomes compressed or constricted, the resulting symptoms are known as myelopathy.

Myelopathy Versus Myopathy

Myopathy is a muscular disorder and should not be confused with myelopathy, which has to do with nerve damage inside the spinal cord.

Myelopathy Versus Radiculopathy

Myelopathy may sometimes be accompanied by radiculopathy. Radiculopathy is the term used to describe pinching of the nerve roots as they exit the spinal cord or cross the intervertebral disc, rather than the compression of the cord itself (myelopathy).

Types of Myelopathy

Myelopathy can occur in any area of the spine and has a different name depending on where in the spine it appears.

Cervical Myelopathy

Cervical myelopathy occurs in the neck and is the most common form of myelopathy. Neck pain is one of the symptoms of cervical myelopathy, but not all patients experience it.

Thoracic Myelopathy

Thoracic myelopathy occurs in the middle region of the spine. The spinal cord in this area typically gets compressed due to bulging or herniated discs, bone spurs, or spinal trauma.

Lumbar Myelopathy

Lumbar myelopathy is a rare condition because in most people, the spinal cord ends in the top section of the lumbar spine. However, if the spinal cord is low-lying or tethered, it can be affected by lumbar myelopathy.

Causes of Myelopathy

As you age, inflammation, arthritic illness, bone spurs and the flattening of the spinal discs between the vertebrae can put pressure on the spinal cord and the nerve roots. Myelopathy typically develops slowly as result of the gradual degeneration of the spine (spondylosis), but it can also take an acute form or stem from a spine deformity present at birth.

• Common causes of myelopathy are degenerative spinal conditions, such as spinal stenosis, a narrowing of the bony passageways of the spine through which the spinal cord and nerve roots travel.
• Central disc herniations can also result in compression on the spinal cord, leading to the development of myelopathy.
• Autoimmune disorders, such as rheumatoid arthritis in the spine, can also lead to degenerative changes in the vertebrae that result in spinal cord compression and myelopathy.
• Hernias, cysts, hematomas and spinal tumors, including bone cancer, may also press on the spinal cord and lead to myelopathy.
• Acute myelopathy can develop quickly as a result of a spinal injury, spinal infection, inflammatory disease, radiation therapy or neurological disorders.

Below is an example of how a herniated disc may press on the spinal cord, leading to myelopathy.

Symptoms of Myelopathy

When the spinal cord is compressed or injured, it may cause a loss of sensation, loss of function, and pain or discomfort in the area at or below the compression point. Myelopathy symptoms may include:

• Neck, arm, leg or lower back pain
• Tingling, numbness or weakness
• Difficulty with fine motor skills, such as writing or buttoning a shirt
• Increased reflexes in extremities or the development of abnormal reflexes
• Difficulty walking
• Loss of urinary or bowel control
• Issues with balance and coordination

The exact symptoms will depend on where in the spine myelopathy is present. For example, cervical myelopathy is likely to have symptoms in the neck and arms.

Myelopathy Diagnosis

Symptoms of myelopathy are not unique to this condition. Your doctor may recommend the following tests to narrow down the myelopathy diagnosis:

• An X-ray to rule out other problems
• An MRI scan for a detailed look of the spine and spinal canal, which can show areas of stenosis
• Myelography uses a contrast material and a real-time form of an X-ray called fluoroscopy to reveal abnormalities of the spinal cord. It is sometimes used instead of MRI for patients who can’t be inside an MRI machine.
• Electrical tests, such as an electromyogram or somatosensory evoked potentials, show how well your nerves are functioning to provide sensation and movement ability to your arms and legs. These tests measure how nerve stimulation in a hand, arm, leg or foot is connecting through the spinal cord to the brain.

The diagnosis itself may be communicated to you by your doctor in several different ways. Sometimes, myelopathy is added at the end of another underlying condition to indicate the involvement of the spinal cord. For example, your doctor may tell you that you have cervical stenosis with myelopathy or thoracic disc disorder with myelopathy. Similarly, if the spinal cord is not involved, your diagnosis may say without myelopathy, as in displaced lumbar intervertebral disc without myelopathy.

If myelopathy is a complication of another disease, your doctor may refer to it in the terms of this disease. For example, diabetic myelopathy means that the spinal cord has been damaged due to diabetes. Carcinomatous myelopathy means that the spinal cord has suffered damage due to a carcinoma.

Myelopathy Treatment

Myelopathy treatment depends on the causes of myelopathy. However, in some cases, the cause may be irreversible, so the treatment may only go as far as helping you relieve the symptoms or slowing down further progression of this disorder.

Nonsurgical Myelopathy Treatment

Nonsurgical treatment for myelopathy may include bracing, physical therapy and medication. These treatments can be used for mild myelopathy and are aimed at reducing pain and helping you return to your daily activities.

Nonsurgical treatment does not remove the compression. Your symptoms will progress — usually gradually, but sometimes acutely, in some instances. If you notice progression of your symptoms, talk to your doctor as soon as possible. Some of the progression can be irreversible even with treatment, which is why it’s important to stop any progression when identified in the mild stages.

Surgical Myelopathy Treatment

Spinal decompression surgery is a common treatment for myelopathy to relieve pressure on the spinal cord. A surgery can also be used to remove bone spurs or herniated discs if they are found to be the cause of myelopathy.

For advanced myelopathy caused by stenosis, your doctor may recommend a surgical procedure to increase the channel space of your spinal cord (laminoplasty). This is a motion-sparing procedure, which means your spinal cord retains flexibility at the site of the compression. For various reasons, some patients may not be candidates for a laminopasty. An alternative is decompression and spinal fusion that can be done anteriorly (from the front) or posteriorly (from the back). During spinal fusion, vertebrae are fused to eliminate motion in the affected segment of the spine.

Minimally invasive spine surgery may offer relief with a lower risk for complications and a potentially faster recovery than conventional open surgery procedures.

While you’re awaiting surgery, a combination of exercise, lifestyle changes, hot and cold treatments, injections, or oral medication can help you control any pain symptoms. It’s very important to take any medications exactly as your doctor prescribes them, since many pain medicines and muscle relaxers can cause side effects, especially when used for a long time.

Lumbar Myelopathy | Spine Care

Key Points about Lumbar Myelopathy 

• Lumbar myelopathy occurs when the spinal cord is compressed.
• Lumbar myelopathy is diagnosed using imaging tests and electrical studies.
• The most common treatment for lumbar myelopathy is decompression surgery.

 

Common related conditions

Compression Fractures
Disc (Disk) Herniation
Sciatica

Myelopathy is an injury that occurs due to severe compression to the spinal cord. This compression may result from trauma, congenital stenosis, degenerative disease or a herniated disc. Lumbar myelopathy occurs when the middle area of the spine is compressed.

Lumbar myelopathy causes 

The various causes of lumbar myelopathy include:

• Bone spur
• Cyst or hematoma in the spine
• Degenerative spine conditions, such as spinal stenosis (narrowing of the bones of the spine that compresses the spinal nerves)
• Herniated disc
• Rheumatoid arthritis in the spine
• Spinal injury or infection
• Spinal tumor, including bone cancer

Lumbar myelopathy risk factors

If you have any of the following conditions, your risk developing lumbar myelopathy may increase:

• Bone cancer or a spinal tumor
• Herniated disc
• Rheumatoid arthritis in your spine
• Spinal stenosis
• Spine infection
• Traumatic spinal injury

Lumbar myelopathy symptoms

Signs and symptoms of lumbar myelopathy include:

• Difficulty with coordination
• Difficulty with fine motor skills, such as holding a pen to write or using a zipper
• Pain in the neck, arm, leg or lower back
• Tingling, numbness or weakness
• Trouble keeping your balance
• Trouble walking
• Urinary or stool incontinence

Lumbar myelopathy diagnosis

Your specialist may use the following tests to diagnose your lumbar myelopathy:

X-ray. Your specialist may order an X-ray to rule out any other conditions that can cause similar symptoms.

Magnetic resonance imaging (MRI). Your doctor may order an MRI to obtain a detailed image of your spine and spinal cord.

Electrical tests. Your specialist may order an electrical test – such as an electromyogram or somatosensory evoked potentials – to check how well your nerves are working.

Lumbar myelopathy treatment

Your doctor may recommend one or more of the following treatments for your lumbar myelopathy:

Medication. Your specialist may recommend medications to help relieve pain associated with your lumbar myelopathy.

Physical therapy. You may work with a physical therapist to help you how to more easily complete daily tasks. As part of this, you may need to wear a brace.

Spinal decompression surgery. In this procedure, your specialist removes the cause of your lumbar myelopathy, such as a bone spur or herniated disc.

Laminoplasty. In this treatment for more advanced types of myelopathy, your specialist widens the space through which your spinal cord passes. This helps to relieve pain and other symptoms.

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a spine specialist for more specialized treatment.

Find a spine specialist near you

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symptoms, diagnosis, treatment and prognosis

Content

• 1 Myelopathy of the lumbar spine: symptoms, diagnosis, treatment and prognosis
  • 1.1 Myelopathy of the lumbar spine
  • 1.2 Myelopathy of the lumbar spine: main symptoms 900 08
  • 1.3 Causes of myelopathy of the lumbar spine
  • 1. 4 Diagnosis of myelopathy of the lumbar spine
  • 1.5 Diagnosis and treatment of myelopathy of the lumbar spine: which doctor will help
  • 1.6 Treatment of myelopathy of the lumbar spine
  • 1.7 Opportunities for surgical intervention in myelopathy of the lumbar spine
  • 1.8 Treatment of myelopathy of the lumbar spine: how is efficiency achieved?
  • 1.9 How to Maintain a Healthy Lumbar Spine
    • 1.9.1 Maintain Correct Posture
    • 1.9.2 Distribute the Load Evenly
    • 1.9.3 Wear the Right Shoes
    • 1.9.4 Choose the right mattress and pillow
    • 1.9.5 Monitor your weight
  • 1.10 Prognosis for lumbar myelopathy
  • 1.11 Additional advice for people with lumbar myelopathy of the spine
  • 1.12 Question-answer:
    • • 1.12.0.1 What symptoms are typical for myelopathy of the lumbar spine?
      • 1.12.0.2 How is myelopathy of the lumbar spine diagnosed?
      • 1.12.0.3 What treatment is recommended for myelopathy of the lumbar spine?
      • 1. 12.0.4 Can myelopathy of the lumbar spine lead to paralysis?
      • 1.12.0.5 What is the prognosis for myelopathy of the lumbar spine?
      • 1.12.0.6 Can exercise help treat myelopathy of the lumbar spine?
  • 1.13 Related videos:

Find out about the symptoms, diagnosis, treatment and prognosis of lumbar spine myelopathy on our website. All the information you need in one article.

Myelopathy of the lumbar spine is a disease characterized by dysfunction of the spinal cord. It can manifest itself in the form of lower back pain, numbness and weakness of the lower extremities, urination and defecation disorders are possible. Myelopathy can be caused by compression of the spinal cord as a result of bends and deformities of the spine, diseases of the bones and joints, tumors and disc herniation.

Diagnosis of myelopathy requires a comprehensive examination, including MRI and X-ray, laboratory tests and neurological examination. Specialists should identify the site of signal obstruction, determine its severity and determine the cause.

Treatment of spinal myelopathy can include both conservative methods (exercise, drug therapy, physical therapy) and surgery. However, the decision on the method of treatment should be made individually, based on the general condition of the patient and the degree of development of the disease.

The prognosis of spinal myelopathy also depends on many factors, including age, degree of spinal torsion, diagnosis, and treatment. Early detection and prevention of diseases of the musculoskeletal system can reduce the likelihood of developing myelopathy.

Myelopathy of the lumbar spine

Myelopathy of the lumbar spine is a disease that is associated with a malfunction of the spinal cord in the region of the lumbar spine. It manifests itself in the form of a feeling of numbness and weakness in the legs, lower back pain, changes in reflexes, impaired coordination of movements and other symptoms.

Myelopathy of the lumbar spine can be caused by a variety of causes such as herniated discs, spondylosis, tumors, and other conditions that compress the spinal cord.

To diagnose myelopathy of the lumbar spine, tests are performed to identify the presence of symptoms and determine the cause of the disease. Depending on this, treatment methods are prescribed, which may include conservative methods, physiotherapy, surgical interventions and other methods.

Myelopathy of the lumbar spine: main symptoms

Low back pain: constant, dull or sharp, may be aggravated by movement and sitting. Pain in the legs, hips, or buttocks may also occur.

Decreased sensation: The legs may first become numb, then the legs may feel cold or hot and tingling.

Decreased motor function: patients become more clumsy and unable to perform many movements. When walking, an incorrect distribution of the load is possible and they stagger when moving.

Loss of balance: due to decreased motor function, patients may lose balance and fall. This is especially evident when climbing stairs and when moving quickly.

Blood pressure spike: Patients may experience palpitations, dizziness, and lightness in the head when changing body position.

Reduced urinary function: patients may experience difficulty in urination, frequent desires or, conversely, urinary retention.

Yes, I measure with a glucometer

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Yes, I take tests

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Causes of myelopathy of the lumbar spine

Myelopathy of the lumbar spine develops due to compression of the spinal cord and nerve roots in the lumbar region. The main reasons for this compression are:

• Osteochondrosis of the spine. Changes in the structure of the intervertebral discs lead to their displacement towards the spinal cord.
• Spondylosis. This is a disease in which osteophytes occur at the top of the vertebrae, which also leads to compression of the spinal cord.
• Herniated disc. If the hernia is located in the lumbar region and compresses the spinal cord or roots, this can lead to the development of myelopathy.
• Spinal injuries. Incomplete or improperly treated injuries can lead to the development of myelopathy.
• Inflammatory processes. Inflammation of the tissues of the spine can cause swelling and compression of the spinal cord or roots.

It is important to understand that lumbar spine myelopathy is a serious disease that can lead to a deterioration in the patient’s quality of life. Therefore, it is necessary to consult a doctor in a timely manner and undergo regular preventive examinations for the timely detection and treatment of this disease.

Diagnosis of myelopathy of the lumbar spine

Myelopathy of the lumbar spine is a serious disease that poses a threat to the patient’s quality of life. Diagnosis of this disease is carried out by specialists of various medical specialties based on a comprehensive examination of the patient.

At the beginning of the diagnosis, the doctor examines the patient, asks about his symptoms and medical history, and performs a neurological and orthopedic analysis. Then, to confirm the diagnosis, additional research methods are carried out, such as radiology, computed tomography (CT) and magnetic resonance imaging (MRI).

X-ray can determine the presence and degree of spinal deformity, as well as detect prolapsed intervertebral discs. CT and MRI provide a more detailed picture, allowing you to see not only the structure of the spine, but also to determine the spots of cerebral pressure on the nerve fibers.

Electromyography and CBC can also be used to diagnose lumbar spinal myelopathy to rule out other possible conditions that may produce similar symptoms. Based on the results of a comprehensive examination, doctors prescribe the treatment that will be the best way to deal with myelopathy of the lumbar spine.

Diagnosis and treatment of myelopathy of the lumbar spine: which doctor will help

Myelopathy of the lumbar spine is a serious disease that requires immediate medical attention. For accurate diagnosis and proper treatment of the patient, you should contact a neurosurgeon or neurologist.

Diagnosis begins with a doctor’s examination, which will reveal the characteristic symptoms of the disease. Computed tomography, magnetic resonance imaging, as well as x-rays and other research methods may be required to confirm the diagnosis. Depending on the severity of the disease and its causes, appropriate therapeutic measures are prescribed.

Myelopathy of the lumbar spine can be treated with medication, physiotherapy, massage, spinal manipulation, and other methods.

It is important to remember that myelopathy of the lumbar spine involves different body systems, and treatment must be comprehensive and individual for each patient. Only a qualified doctor with extensive experience in this disease can properly diagnose and treat lumbar myelopathy.

Treatment of myelopathy of the lumbar spine

Myelopathy of the lumbar spine is a serious disease that requires comprehensive and timely treatment. The main goal of treating myelopathy is to prevent further progression of the disease and improve the patient’s quality of life.

The main treatments for myelopathy of the lumbar spine include:

1. Drug therapy – the use of anti-inflammatory and pain medications, as well as muscle relaxants to relieve muscle spasm.
2. Physiotherapeutic procedures – ultrasound treatment, electrical stimulation, kinesiotherapy, magnetotherapy.
3. Massage and therapeutic exercises aimed at strengthening and stretching muscles, improving blood supply and microcirculation in the spine.
4. Mode of physical activity – prevention of prolonged parking and sitting in one position, regular walks and light physical activity in accordance with the recommendations of the attending physician.
5. Surgical treatment – is used only in severe cases, when conservative treatment does not give the desired result, and consists in the removal of damaged areas of the spine.

Signs of improvement are shown within a few weeks after the start of treatment. The trick to treating myelopathy of the lumbar spine lies in the timely diagnosis of the disease and the initiation of treatment in the early stages. This allows you to reduce the treatment time and increase the percentage of positive results.

Opportunities for surgical intervention in case of myelopathy of the lumbar spine

Myelopathy of the lumbar spine is a rather serious disease that manifests itself as a dysfunction of the brain and spinal cord. One of the most significant methods of treatment and achieving the maximum effect is surgery.

Surgical intervention can be carried out in case of detection of depressions, hernias, tumors and other pathologies in the lumbar spine that cause myelopathy. Also, depending on the form of the disease, a number of operations for compressive myelopathy are provided.

The choice between surgical and conservative treatment is made depending on the severity and nature of the development of myelopathy. However, in cases of moderate to severe myelopathy, surgery is the most effective treatment.

Some of the main types of operations for myelopathy of the upper or middle spine: microdecompression, conservative treatment, dyskephtomy, correction of the structure of the spine, anterolisthesis, multilevel dyskeftomy.

Every operation uses a minimally invasive technique to ensure minimal trauma to the patient. In most cases, patients recover quickly after surgery and can return to their normal lives.

Treatment of myelopathy of the lumbar spine: how is efficiency achieved?

Myelopathy of the lumbar spine can lead to a significant deterioration in the patient’s quality of life. This disease is manifested by various neurological symptoms, which can lead to restrictions in movement and performance.

Currently, there is no single approach to the treatment of myelopathy of the lumbar spine. Treatment should be individualized and depends on many factors, such as the cause of the disease, the degree of damage to the nervous structures, the presence of concomitant diseases.

An integrated approach is used to achieve the effectiveness of the treatment of myelopathy of the lumbar spine. This may include drug therapy, physical rehabilitation, manual therapy, acupuncture, surgery, and other methods.

For each patient, an individual set of therapeutic measures is selected, which is aimed at reducing pain, improving functionality, and preventing further development of the disease.

• Medication: may include analgesics, anti-inflammatory and muscle relaxants;
• Physical rehabilitation: physiotherapy, stretching exercises, exercises to strengthen the back muscles;
• Manual therapy and acupuncture: aimed at relieving muscle tension and improving blood circulation;
• Surgery: may be recommended in severe cases where conservative treatment fails;

It is important to remember that the effectiveness of the treatment of myelopathy of the lumbar spine depends on the timely visit to the doctor and the correct choice of a set of therapeutic measures. Therefore, at the first signs of neurological symptoms, it is necessary to consult a specialist and undergo a comprehensive examination.

Keeping Your Lumbar Spine Healthy

Maintain Good Posture

Posture plays a big role in spinal health. Try to sit and stand straight, do not bend or bend. With the “humpback” position, the risk of developing myelopathy increases.

Distribute the load evenly

When exercising, especially lifting weights, do not overload the lumbar spine. It is better to distribute the load on all muscle groups and work under the supervision of a trainer.

Wear the right shoes

Wearing the wrong shoes can damage your spine. Choose shoes with stable soles and good cushioning to reduce impact on your lower back.

Choose the right mattress and pillow

Lying on a comfortable mattress and pillow promotes proper spinal alignment during sleep and helps reduce the risk of myelopathy.

Watch your weight

Being overweight puts extra strain on your spine, especially the lumbar region. Maintain a healthy weight through a balanced diet and moderate exercise.

Prognosis for myelopathy of the lumbar spine

The prognosis for myelopathy of the lumbar spine can be relatively favorable with timely and effective treatment. However, it all depends on the degree of damage to the myelon, the age of the patient and the presence of other diseases.

If myelopathy appears at an early age, then the prognosis may be somewhat better than at an older age. With severe violations of the final activity, without timely and effective treatment, the prognosis may be unfavorable.

One factor that influences prognosis is the cause of the myelopathy. If the cause is degenerative changes in the spine, then most patients have a favorable prognosis. If the cause is unknown or associated with infectious diseases, then the prognosis may be less optimistic.

Some patients may have continued sensory and motor disturbances even after treatment, especially if the pathological changes in the spine were significant enough.

However, with proper treatment, including drug therapy, physical therapy, and in some cases surgery, many patients can achieve full or partial recovery of function.

Additional recommendations for people with myelopathy of the lumbar spine

Exercise and physical activity. The basic rule in the treatment of lumbar myelopathy is moderate exercise, specialized exercise and regular physical activity. This helps to strengthen the muscles of the back and reduce the load on the spine. Walking, swimming, various exercises for stretching the back muscles, etc. are recommended.

Regular massage and stretching. In addition to exercise, massage can help reduce pain and strengthen back muscles. It is often recommended to do regular stretches targeting different areas of the back to relieve pressure on the spine.

Watch your diet. It is recommended to follow a diet aimed at strengthening muscles. It is also important to maintain a normal weight so as not to increase the load on the spine.

Avoid certain activities. Patients with lumbar myelopathy are advised to avoid certain activities that cause spinal mobility. Your doctor can give you more advice on which activities to avoid, depending on the severity of your illness.

Q&A:

What are the symptoms of myelopathy of the lumbar spine?

Characteristic symptoms of myelopathy of the lumbar spine include: back pain, numbness or burning sensation in the legs, loss of sensation and muscle strength in the legs, frequent falls, problems with coordination of movements.

How is myelopathy of the lumbar spine diagnosed?

Diagnosis of myelopathy of the lumbar spine includes neurological examination, X-ray and MRI examination of the spine, electromyography and computed tomography. It is also necessary to exclude other diseases that can lead to similar symptoms.

What treatment is recommended for myelopathy of the lumbar spine?

Treatment of myelopathy of the lumbar spine may include long-term physical therapy, but if this does not help, surgery may be required. In any case, with such a disease, you should immediately consult a doctor.

Can myelopathy of the lumbar spine lead to paralysis?

Yes, myelopathy of the lumbar spine can lead to impaired movement in the legs and even paralysis if left untreated. Therefore, it is important to consult a doctor in a timely manner and undergo regular medical examinations.

What is the prognosis for myelopathy of the lumbar spine?

The prognosis depends on the degree of development of the disease and the timeliness of the start of treatment. If treatment is started in the early stages of the disease, the prognosis may be favorable. However, with an advanced form of lumbar spine myelopathy, the prognosis may be less optimistic.

Can exercise help treat myelopathy of the lumbar spine?

Exercise can help strengthen muscles and improve coordination, but is not a good treatment on its own. In any case, the appointment of exercises should be carried out only by a doctor, under his supervision and depending on the degree of development of the disease.

Related videos:

Myelopathy – Avicenna Klinik

• Start page
• Diseases of the spine
• Myelopathy

What is myelopathy?

If there is damage to the nerve tissue in the spinal cord of the cervical or thoracic spine, we speak of myelopathy. The word “myelopathy” consists of the ancient Greek parts Myelon – “spinal cord” and Pathos – “disease, injury”. Inside the spine is the spinal canal, it contains the spinal cord, and in the lower spine – nerve fibers. Between the vertebral bodies, the nerves leave the spinal canal and exit further into the arms, trunk, or legs. If there is constant massive pressure on the spinal cord, for example, in the case of a herniated disc, spinal stenosis, tumor or circulatory disorders, then the tissues of the spinal cord lose their vitality, and over time this leads to the death of the nervous tissue with the loss of its functions. Since the nerve cells in this area cannot regenerate or multiply, the effects of the disease are either permanent or worse.

There are different types of myelopathy depending on the cause of spinal cord injury. The location of the spinal cord injury is decisive, i.e. whether the spinal cord is affected in the cervical or thoracic region.

Frequency – men are ill twice as often as women

It is known from experience that men suffer from this problem twice as often as women. Degenerative changes in the cervical spine mainly affect middle-aged and elderly people. Half of all people over 50 and three-quarters of all people over 65 have cervical myelopathy. You may be interested: in a Japanese study in one area of ​​2.26 million people, 1,155 patients were operated on for cervical (neck) myelopathy. Most of the patients were between the ages of 60 and 70. Spinal stenosis was present in 30% of cases.

Myelopathy has different causes

Naturally, you want and need to know the causes of myelopathy.

And here are the answers. The rule of thumb is that spinal cord injury can be caused by a variety of mechanisms. However, in the vast majority of cases, it is acquired during life. If the spinal canal is too narrowed, it can lead to severe hand and foot failures with impaired fine motor skills, sensation, muscle strength, and gait. Incomplete or complete transverse paralysis may result if the spinal canal is not widened.

How can you “earn” myelopathy? Narrowing (stenosis) of the spinal cord and resulting damage to the nerve pathways and nerve roots can occur due to acute traumatic circumstances, such as an accident, herniated disc or fall, but also due to tissue changes during / after inflammation, as well as tumors or cysts. Different causes cause different types of myelopathy.

There are three forms of the disease! The first form is compression myelopathy. It can occur as a result of a tumor, metastases in the spine and spinal cord membranes, as well as post-traumatic, for example, after a fracture of the vertebrae, after an intervertebral hernia, due to spinal stenosis, spondylosis (wear and tear). In addition to compressive myelopathy, reduced blood flow also damages nerve cells in the spinal cord. Violation of blood circulation occurs with vascular defects or vascular narrowing (stenosis). Acute blood loss can also lead to insufficient supply to the spinal cord (shock symptoms). If these causes are present, then we speak of vascular myelopathy. You’ve probably heard of radiation damage before. Indeed, as part of radiation therapy, damage to the spinal cord can occur. If so, then we are talking about radiation myelopathy.

In myelopathy, symptoms develop slowly.

Myelopathy draws attention to itself with various symptoms. They depend primarily on the area of ​​damage to the spinal cord. Symptoms usually develop insidiously. With pure spinal cord compressions, which are usually painless, it can take years from the onset of the first symptom to a diagnosis. The first signs may be sensory disturbances in the hands or soles of the feet, clumsiness of the hands, and uncertainty when walking in the dark. For all forms of myelopathy, the rule is that the damaged areas of the spinal cord can no longer properly perform their function in the nervous system, so neurological disorders occur.

Some patients complain of neck pain that radiates to the arms or numbness, up to and including loss of strength in the arms. Important signs of myelopathy are not even pain, but neurological disorders. It is also typical to “fall asleep” of the hands during a night’s sleep. Initial symptoms may include increasing stiffness of the neck with pain when turning the head to the left and right. If the spinal cord is injured, symptoms may radiate to the legs, as well as cause unsteady gait and loss of bladder or bowel control. Fine motor skills disorders of the hands may increase, the handwriting becomes angular and scribble-like, objects may fall out of the hands more often. It becomes more difficult to fasten buttons on a shirt and blouse. Cervical myelopathy has a progressive form of flow. At the onset of the disease, there are mild motor failures (gait disturbances) and dysfunctions of the upper and / or lower extremities. Due to unilateral compression, sensory disturbances and progressive movement problems (Brown-Séquard syndrome) can occur.

Myelopathies of the thoracic spine (thoracic myelopathies) have the same typical symptoms as myelopathies in the CS area. Symptoms come on slowly and are the result of loss of function in each of the affected spinal areas. Stiffness in the legs, weakness in the muscles of the arms, shortness of breath, atrophy of the muscles of the arms or hands, disturbances in the sensitivity of the hands, disturbances in gait, disturbances in sensitivity, paralysis, and dysfunctions of the bladder and intestines are characteristic.

Vascular myelopathy manifests itself in various functional failures depending on the affected vessel. Patients complain of weakness, numbness, impaired fine motor skills, impaired bladder emptying, balance and sexual function, as well as muscle stiffness. At an advanced stage of the disease, tissue atrophy and difficulty in breathing may occur.

It is difficult for a doctor to diagnose myelopathy

Basically, two things must be said about the topic of diagnosing myelopathy:

• Accurate diagnosis is a prerequisite for suitable treatment.
• The earlier the diagnosis is made, the better the prognosis for a full recovery. This is obvious, and it is possible that you yourself have already experienced this for yourself. Motto: quickly recognize – quickly eliminate!

However, myelopathy makes it difficult for a doctor to diagnose, and there is a reason for this: there are no specific early signs to detect it. In other words, the disease process very often proceeds imperceptibly and inconspicuously, so that the diagnosis is often made only with a progressive picture of the disease. This, apart from the disease itself, is the most insidious thing about myelopathy.

For this reason, it is particularly important to “drive on a two-way road” when diagnosing. In other words, it means talking to a doctor and having a clinical examination. First, the doctor will ask you about the nature of the symptoms (failure of some bodily functions, pain, dysfunction of the bladder or rectum). Secondly, he will ask about previously known diseases: ankylosing spondylitis, spondyloarthrosis, osteoporosis, herniated disc, arterial circulation disorders or radiation therapy.

Neurological status follows with gait checks, pathological reflex tests and sensory disturbances (loss of sensation).

Imaging diagnostics such as MRI (Magnetic Resonance Imaging) is then used. Plain x-rays can also represent bone changes well. Additional functional imaging should always be taken to determine possible instabilities.

Magnetic resonance imaging (MRI) is the most important diagnostic tool for determining myelopathy. Myelopathy is clearly visible in layered images of magnetic resonance imaging. Thus, it is SHE that is the method of choice for diagnosis. First, it allows you to see structures that compress the spinal cord, such as a herniated disc or tumors. On the other hand, damaged areas of the spinal cord on MRI can be distinguished from healthy nervous tissue. Electrophysiological measurements (velocity of the nerve impulse, evoked potentials, etc.) provide important information about the functions of the spinal cord.

Usually the doctor also sends the patient to a laboratory blood test to identify possible inflammatory processes in the body.

There are different degrees of myelopathy. Below is the European Myelopathic Score. See how you are doing:

European Myelopathic Scale (EMS)

9038 8 9 C. Second motor neuron functions 400

A. Functions of the first motor neuron (gait)	points
Impossible to walk, assistance needed walking aid/support	2
Climbing stairs only with walking aid/support	3 9000 3
Unsteady gait, gait pattern seems awkward	4
Unchanged gait	5
B. Functions of the first motor neuron and afferent system	Points 9039 3
Urinary incontinence, uncontrolled	1
Incomplete emptying and irregular frequency	2
Normal bladder and bowel function	3
Writing/eating with cutlery not possible	1
Writing/eating with cutlery limited	2
Letter/lace-up awkward 7	Normal handwriting/fine motor skills	2 D. Functions of the posterior column of the spinal cord (proprioception and coordination)	Points
Dressing/undressing only with assistance	1
dressing 0002 3
E. Rear roots (segmental radicular paresthesia /pain)	9000 points 9000 9000 9000 9000 9000 9000 9000 9000 3
Disabled pain	1
Endurable paresthesia/pain	2
Absence of paresthesia/pain	3 0390 Sum: Classification by points
Points
5-8	Grade III
9-12	900 02 Grade II
13-16	Grade I
17-18 90 393	Normal

See a specialist for back pain

It is always important to listen to your body. So be your own inner doctor. If you take this task seriously, and you should, after all, this is about your health, then there are a few things you should know and do. So, if you have been experiencing severe back pain in certain areas for a long time, or even functional failures or false sensations, then immediately consult a doctor. This should be a spinal specialist, neurosurgeon or orthopedist.

When it comes to surgery, you should think positively, that is, about 90% of all patients improve. Improvement is, of course, most evident when the problem is detected at an earlier stage and treated in a timely manner. Since today’s operations on the CS are performed more sparingly and quickly, the patient is mobilized the very next day after the operation. The patient’s head is supported by a soft collar for another one to two weeks.

It is also reassuring that in the operated and calmed segment of the spine, the disease no longer occurs.

Better than any cure is known to be prevention. Here’s a couple of tips:

• Avoid unilateral loads.

• Avoid prolonged bad posture.

• Move regularly.