Cervical Myelopathy

Also Called: Cervical spondylotic myelopathy (CSM), spinal cord compression in the neck.

What It Is

Myelopathy means the spinal cord itself is under pressure, beyond any single nerve root. In the neck it develops gradually as bone spurs, a bulging disc, and thickened ligament narrow the space around the cord. The cord carries signals to and from the whole body below the neck. Compressing it affects the hands, legs, balance, and coordination. A pinched nerve, by comparison, causes pain in one specific area.

Causes & Risk Factors

Age-related degeneration is the most common cause. Some people are born with a narrow canal, so less change is needed before symptoms appear. An injury to an already-narrowed neck, from a fall or car accident, can bring on or worsen symptoms suddenly.

Symptoms

• Clumsiness or weakness in the hands
• Difficulty with fine motor tasks
• Heaviness or stiffness in the arms or legs
• Balance problems
• Symptoms are often subtle at first and can be mistaken for normal aging

Diagnosis

On exam, reflexes that are exaggerated rather than diminished are one signal that points toward the spinal cord rather than a single nerve root. Weakness, numbness, and trouble with balance or fine hand movements are others. An MRI confirms the compression and shows how much space remains around the cord. X-rays add a look at alignment, and a CT sometimes helps when bone spurs are contributing to the narrowing.

Treatment

Myelopathy involves the spinal cord rather than a single nerve, so its course is different from a typical disc problem. Non-surgical care, including physical therapy and a period in a soft collar, can ease symptoms in milder cases. It does not create more room around the cord, though, and does not reverse the compression. For that reason, cervical myelopathy is generally treated surgically once the diagnosis is confirmed, particularly when neurological changes are present or progressing.