Diagnosis
Anamnesis already provides indications of a myelopathy. It is important to ask about specific symptoms such as paralysis, sensitivity disorders or pain in the spinal column. The clinical examination provides further certainty, as reflexes can be conspicuous, for example, and the gait pattern can be altered.
To confirm the diagnosis, magnetic resonance imaging is used as an imaging diagnostic tool.In special cases, such as suspected vascular myelopathy, spinal angiography is recommended. Myelography may also be indicated. In this procedure, contrast medium is injected into the spinal canal under x-ray imaging to show the space conditions of the spinal cord and the exiting nerves.
Magnetic resonance imaging is the most important examination method for detecting myelopathy. On the one hand, structures that compress the spinal cord, such as a herniated disc or tumors, can be seen using MRI. Vascular changes can also be visualized.
On the other hand, damaged regions of the spinal cord can be distinguished from healthy nerve tissue in the MRI image. In individual cases, computer tomography can be useful as a supplement to the image if questions concerning bony structures arise. The term myelopathy signal comes from imaging diagnostics.
It is used by radiologists primarily to describe magnetic resonance imaging (MRI) examinations. One speaks of a myelopathy signal when imaging indicates damage to the spinal cord (myelon). This can be the case, for example, in the case of edema (accumulation of fluid) or a tumor in the spinal cord.
A myelopathy signal is non-specific, i.e. it occurs independently of the cause of the spinal cord damage. The damage to the spinal cord can therefore only be temporary. The patient does not always have serious symptoms.
Therefore, in addition to a myelopathy signal, its cause and the patient’s symptoms are decisive for therapy. The spinal cord cannot really be assessed very well in a conventional X-ray image. Even in a CT examination, damage to the spinal cord cannot be ruled out with absolute certainty.
Therefore, the MRI examination is the method of choice for the diagnosis of myelopathy. Depending on the cause of the myelopathy, a distinction is made between different therapeutic options. Firstly, there is the option of conservative therapy, which is symptom-oriented.
In case of pain, the patient is given painkillers, whereby the so-called NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen, diclofenac) are particularly suitable for this purpose, as they also have an anti-inflammatory and decongestant effect. A muscle-relaxing medication often also leads to the alleviation of the complaints. In addition, a physiotherapeutic treatment is used.
The actual cause of the myelopathy must usually be treated surgically, so that, for example, in the case of compression myelopathy, the pressure on the spinal cord is removed. In general, the prognosis of the disease is best with an early diagnosis and the initiation of a rapid and adequate therapy. The faster the damage to the affected nerve cells is counteracted, the higher the probability that the corresponding spinal cord section can regenerate.
In a surgical intervention on the spinal column, an attempt is made to relieve the pressure on the spinal cord damaged by pressure. Various surgical techniques are used, whereby a distinction is made between access from the front or the back. For example, in the area of the cervical spine, access from the front is now more frequently chosen, with the patient lying on the operating table in a supine position during the operation.
Before the skin incision is made, the position of the vertebra to be operated on is checked using a mobile X-ray machine. In order to reach the affected area, the structures located at the front of the neck, such as muscles, thyroid gland or large blood vessels are pushed to the side. Excess tissue in the area of the spinal canal can now be removed using special instruments.
If the disc cannot be preserved, a ceramic or titanium spacer is inserted. If you fill this placeholder with bone substance, you can connect the two adjacent vertebral bodies with each other and thus achieve good stability. The procedure is always performed under general anesthesia.
Depending on its complexity, it takes between one and several hours. After the inpatient hospital stay, rehabilitation treatment should follow. It takes up to 4 months until the spine is fully resilient again after the surgical intervention.
