Wear and tear or herniated discs in the cervical spine can cause degenerative restrictions of the spinal cord with neurological deficits. Doctors refer to this as myelopathy.
What is myelopathy?
The medical term myelopathy or cervical myelopathy is composed of the Greek words “myelon” = spinal cord and “pathos” = pain and stands for damage to the spinal cord in the area of the spine. Damage to the spinal cord can cause a range of symptoms, including gait instability, numbness and other neurological problems. The cervical spine is most commonly affected, but myelopathy can occur in other parts of the spine.
Causes
The main cause of myelopathy is spinal cord narrowing, which may be congenital but in most cases is acquired during life. The degenerative changes that lead to myelopathy can be traumatic in nature and triggered by accidents or falls, but they can also result from inflammation, tumor disease, or changes after surgery such as scarring. In most cases, myelopathy is triggered by degenerative changes and wear and tear in the affected area of the spine. They constrict the spinal cord and irritate the nerve roots. Various types of herniated discs can also lead to stenosis of the spinal cord.
Symptoms, complaints and signs
Typical symptoms of myelopathy include neck pain that radiates to the arms, sometimes numbness and a feeling of weakness in the arms. Arms and hands may fall asleep at night. An initial sign may be neck stiffness and limited ability to turn the head to the left or right. If the spinal cord is already damaged, the symptoms may also radiate to the legs, causing unsteadiness when walking and affecting the bladder and bowels. An important identifying sign is the sensation of an electric shock that may occur when the head is bent (Lhermitt’s sign). The more advanced the disease, the more neurological deficits may occur. These include formication, tingling, pain, clumsy walking, problems with coordination, and problems with everyday tasks such as tying shoes or putting on a jacket. In severe cases, paralysis, bladder, bowel and potency problems can occur.
Diagnosis and disease progression
The most important way to diagnose myelopathy is by magnetic resonance imaging (MRI). It most clearly depicts degenerative changes with pressure on the spinal cord. If extensive ossification needs to be treated, computed tomography (CT) is an indispensable tool for visualizing the bones to better plan and assess the surgical procedure. In order to prevent an unfavorable course in time, it is important to make a diagnosis as early as possible. For patients with acute symptoms following a herniated disc, the chance that the symptoms will resolve is greatest if the herniated disc is diagnosed promptly. Changes to the bones can occur slowly and insidiously and are sometimes not noticed immediately or are associated with other problems. Magnetic resonance imaging readily shows degenerative changes in the cervical spine with changes in the cervical spinal cord. Treatment of myelopathy depends on the extent of the damage.
Complications
Myelopathy causes severe neurologic deficits in the patient. These deficits can thus lead to paralysis and further disturbances in sensibility, significantly limiting the patient’s quality of life. Furthermore, movement restrictions also occur, so that patients may be dependent on the help of other people in their daily lives. Those affected suffer primarily from severe pain in the neck and also from a stiff neck. As a result, turning the head is associated with pain. Furthermore, there are also problems with coordination and concentration. The pain can limit everyday life and, in the form of pain at rest, can also lead to sleep problems at night. It is not uncommon for myelopathy to also lead to potency problems. Likewise, the bowel and bladder are affected by the disease.It is not uncommon for those affected to also develop psychological complaints. It is also possible that the underlying disease limits the life expectancy of the affected person due to the myelopathy. In many cases, the damage is irreversible, so that no treatment can take place. However, the symptoms can be alleviated by various therapies. In most cases, however, there is no complete cure for myelopathy. Further complications usually do not occur during treatment.
When should you see a doctor?
Pain in the area of the back or cervical spine should be clarified by a doctor in any case. If the complaints have been present for a long time and become more severe as they progress, there may be a serious underlying condition such as myelopathy that needs to be medically diagnosed and therapeutically treated. Affected individuals are best advised to consult their family doctor. The latter can make an initial diagnosis and refer the patient to an orthopedist if necessary. The actual treatment is carried out by various specialists as well as a physiotherapist. Depending on the severity of the condition, surgical measures may also need to be initiated. Individuals who already have a back condition are at particular risk of developing myelopathy. Elderly people and those with deformities of the back or spine are also at risk and should talk to a doctor early on. The therapy is lengthy and the patient must undergo regular examinations so that complications can be ruled out and, if necessary, treated directly. In addition, regular adjustment of medication is necessary.
Treatment and therapy
In most cases, conservative treatment does not help sufficiently because it does not stop the cause, the spinal cord contusion. Spinal cord contusions and changes in the bones usually cannot resolve on their own. A herniated disc can regress and does not always necessarily require surgery, but it does take a lot of time. If the herniation has caused spinal cord damage, however, surgery must be performed because the symptoms will not go away otherwise. Conservative therapy may sometimes be necessary if patients cannot be operated on because of their increased age or because of concomitant diseases. It involves the administration of analgesic, decongestant, and anti-inflammatory medications. If necessary, a neck brace and bed rest must be prescribed. If pain is not present, physical therapy helps stabilize the cervical spine. During conservative treatment, progress must be monitored closely to quickly detect any deterioration. If neurological impairments or deficits occur, surgery to relieve the spinal cord is inevitable. The operation must always be performed on an inpatient basis. Before the operation, infusions or medication are used to try to induce swelling of the spinal cord. During anesthesia, it must be noted that when positioning the patient, hyperextension of the head must be avoided in order not to squeeze the spinal cord even more. In most cases, the operation is performed from the front, but if the findings are appropriate, it can also be performed from the back. After the operation, decongestant medication is still required for several days. This is usually followed by rehabilitation with exercises to reduce the symptoms. They often cannot be completely cured.
Outlook and prognosis
The outlook for myelopathy is mixed. In principle, the best chances of cure are with early diagnosis and subsequent initiation of therapy. In practice, however, it usually proves problematic that the disease progresses insidiously. There are no sufficient early detection signals. As a result, neurological deficits and changes in the bones can no longer be corrected. Doctors therefore often speak of the insidiousness of myelopathy. The quality of life suffers. The progressive form of progression leads to ever greater discomfort if it is not treated. Acute myelopathy usually brings with it the chance of complete resolution of symptoms. The medical effort is low, depending on the patient’s basic condition. If tumors or other diseases trigger the myelopathy, the success of treatment depends decisively on combating these causes. In most cases, surgery is followed by several weeks of rehabilitation.If necessary, restrictions on stress in everyday life must be accepted. Back-friendly behavior and strengthening of the musculature are indispensable. In the event of a severe course of the disease, some patients are dependent on aids for the rest of their lives. Permanent care may become necessary.
Prevention
Myelopathy, like most spinal disorders, can be effectively prevented by avoiding unilateral movements and chronic poor posture. People who work in offices and have to sit at desks and computers a lot should do regular exercises to relieve pressure on the cervical spine. Regular physical exercise strengthens the back muscles and improves back pain. In case of mild discomfort, physiotherapy exercises help to prevent chronic bad posture in time and relieve the spine.
Aftercare
In most cases, only very limited and also very few measures of direct aftercare are available to the patient with myelopathy. The affected person should therefore see a physician early on to prevent the occurrence of other complications and complaints. The earlier a doctor is consulted, the better the further course of the disease usually is. If the affected person wishes to have children, he or she should first consider genetic testing and counseling in order to prevent the recurrence of the disease in the children. Most sufferers of myelopathy rely on the measures of physiotherapy or physical therapy. Here, many of the exercises can also be performed in the patient’s own home. Many sufferers depend on taking various medications. The affected person should always rely on a correct dosage and also on a regular intake. In case of ambiguity or if there are any questions, the affected person should always contact a doctor first in order to avert possible complications and discomfort in advance.
What you can do yourself
What measures myelopathy patients can take in everyday life depends on the cause and severity of the disease. If there is only an underlying herniated disc, the symptoms can be alleviated by professionally guided physiotherapy. The patient can support the therapy at home with individual exercises. Moderate exercise helps to prevent the disc from slipping out again. If surgery is necessary, the patient primarily requires rest. The operation usually puts a great strain on the spine, which is why strenuous physical activities should be avoided for the first few days after the operation. If necessary, the patient must wear a neck brace and walk with crutches at the beginning. If pain occurs, a relatively strong painkiller must be used to prevent incorrect posture and resulting damage. The patient can support the medication with various remedies from natural medicine. In addition to valerian drops, preparations such as arnica or devil’s claw have proven effective. For acute pain, a hot bath helps. Parallel to these measures, a doctor must monitor the course of the disease. If complications arise, the physician must be informed. It is possible that myelopathy is based on a tumor disease or an inflammation that must be treated first.
