Cervical Myelopathy: Early Signs, Symptoms, and Management

Cervical Myelopathy: Early Signs, Symptoms, and Management

Cervical myelopathy is a condition caused by the compression or damage of the spinal cord in the cervical (neck) region.This compression can result from several factors, including degenerative changes in the spine like cervical spondylosis (age-related wear and tear), disc herniation, or the formation of bone spurs (osteophytes). Other causes can include trauma, tumors, or congenital spinal canal narrowing. It can lead to progressive neurological impairment if left untreated

Early Signs and Symptoms:

Cervical myelopathy can develop slowly, and its symptoms may be subtle at first. Recognizing these early signs is crucial for timely intervention:

• Neck Pain or Stiffness: As the intervertebral discs degenerate, they may bulge or herniate, putting pressure on the spinal cord or nerves, which leads to stiffness in the neck, mild to moderate neck pain, is a common early sign, especially when the spinal cord is under pressure. Over time, the bones in the cervical spine may develop abnormal growths (spurs) that narrow the spinal canal, causing compression and irritation of the spinal cord, which again resulting in pain.
• Weakness in Hands or Arms:  The spinal cord runs through the cervical spine and controls motor functions. When it gets compressed by conditions like disc herniation, bone spurs, or narrowing of the spinal canal (stenosis), it disrupts the communication between the brain and muscles as the compressed spinal cord affects the nerves that supply the arms and hands. Patients may experience difficulty with fine motor skills, such as buttoning a shirt or writing, due to hand weakness or clumsiness. 
• Muscle Atrophy: Prolonged compression may lead to muscle atrophy (wasting away of muscles) because the affected muscles are not receiving proper nerve signals, causing the hands to feel weak .                                             
• Numbness or Tingling:  Cervical myelopathy often results from conditions such as disc herniation, bone spurs (osteophytes), or spinal stenosis, which cause narrowing of the spinal canal. This narrowing compresses the spinal cord, impeding the flow of nerve signals. Sensations of numbness, tingling, or “pins and needles” in the hands, arms, or legs are frequent symptoms as the spinal cord becomes compressed.
• Loss of Balance and Coordination: The loss of balance and coordination in cervical myelopathy is primarily due to the compression of the spinal cord in the cervical (neck) region, which disrupts the neural pathways responsible for proprioception and motor control. As the condition progresses, individuals often develop difficulty walking or maintaining balance, making them more prone to falls.      
• Bladder or Bowel Dysfunction: In severe cases, cervical myelopathy can cause loss of control over bladder and bowel function due to nerve impairment.Bladder and bowel dysfunction in cervical myelopathy occurs due to the compression of the spinal cord, specifically affecting the nerves that control the autonomic functions of the bladder and bowel. The spinal cord relays signals from the brain to the organs that manage these functions, and when the cervical spinal cord is compressed, it disrupts these neural signals, leading to dysfunction.

Management of Cervical Myelopathy:

Managing cervical myelopathy focuses on relieving spinal cord compression and preventing further neurological damage. Treatment depends on the severity of symptoms and the underlying cause.

Non-Surgical Treatments:

• Physical Therapy:  Targeted exercises can help strengthen neck muscles, improve mobility, and alleviate pain. Physical therapy is usually recommended in mild cases or in early stages.
• Physical therapy focuses on strengthening the neck and upper body muscles to improve mobility, reduce pressure on the spine, and maintain posture. It includes exercises that improve balance, coordination, and flexibility.
• Cervical traction may be used to relieve pressure on the spinal cord by gently stretching the cervical spine. 

• Supplement :

• Supplements can serve as a natural approach to managing cervical myelopathy by providing essential nutrients that support nerve health, reduce inflammation, and promote overall spinal wellness. Certain supplements may complement other non-surgical treatments by addressing deficiencies or enhancing the body’s natural healing mechanisms. 
• Medications which can be used for short period of time under medical supervision:
• Anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen help reduce inflammation and relieve pain.
• Pain relievers, anti-inflammatory drugs, and muscle relaxants may be prescribed to reduce pain and inflammation.
• Muscle relaxants may help alleviate muscle spasms often associated with myelopathy.
• Neuropathic pain relievers, such as gabapentin or pregabalin, can target nerve-related pain, numbness, or tingling. 
• Lifestyle Modifications:
• Adjustments such as proper posture,
• avoiding heavy lifting,
• avoid activities that may strain the neck, such as heavy lifting or prolonged neck bending,
• Using ergonomic devices can help manage symptoms and reduce strain on the cervical spine. Patients are advised to make ergonomic adjustments in daily activities, like using supportive chairs and modifying workspaces.

• Cervical Collar:

  • A cervical collar can help stabilize the neck and limit motion to prevent further spinal cord compression, though its use is often temporary.

• Alternative Therapies:

  • Treatments like acupuncture or chiropractic care may provide relief for some patients, though they should be used cautiously. Chiropractic manipulation is often discouraged in cases of myelopathy due to the risk of aggravating spinal cord compression.

Surgical Treatment

Conclusion:

Cervical myelopathy is a potentially serious condition that can lead to irreversible damage if left untreated. Early recognition of symptoms such as neck pain, weakness, and coordination issues is essential for timely management. Treatment options range from conservative approaches like physical therapy to surgical interventions, depending on the severity. Consulting with a healthcare provider early on can significantly improve outcomes and prevent long-term complications.