Cervical Myelopathy: When Spinal Cord Compression in the Neck Becomes Serious
Neck pain is common, but cervical myelopathy is different. It occurs when the spinal cord becomes compressed in the cervical spine, or neck. Because the spinal cord carries signals between the brain and the rest of the body, cervical myelopathy can affect much more than just the neck.
Patients may notice problems with their hands, balance, walking, coordination, and even strength in their arms or legs.
Recognizing these symptoms early is important because cervical myelopathy can progressively worsen if significant spinal cord compression is left untreated.
What Is Cervical Myelopathy?
Cervical myelopathy is dysfunction of the spinal cord caused by compression within the cervical spine.
One of the most common causes is age-related degeneration of the spine. Over time, discs may lose height, bone spurs can form, ligaments can thicken, and the spinal canal may become narrower.
This narrowing is known as cervical spinal stenosis.
When the stenosis becomes severe enough to compress the spinal cord, symptoms of myelopathy can develop.
Other potential causes include:
Herniated cervical discs
Bone spurs
Thickening or calcification of spinal ligaments
Ossification of the posterior longitudinal ligament (OPLL)
Previous neck injuries
Congenitally narrow spinal canals
Less commonly, tumors, infections, or other conditions affecting the spinal canal
What Are the Symptoms of Cervical Myelopathy?
Cervical myelopathy does not always begin with severe pain. In fact, some patients have relatively little neck pain.
Instead, they may notice subtle changes in coordination or function.
Common symptoms include:
Numbness or tingling in the hands
Hand weakness
Difficulty with buttons, zippers, handwriting, or other fine motor activities
Frequently dropping objects
Loss of hand coordination
Weakness in the arms or legs
Problems with balance
Difficulty walking
Feeling unsteady on stairs
Leg stiffness or heaviness
Changes in reflexes
Electric-shock sensations traveling down the spine or extremities with certain neck movements
Some patients describe their hands as feeling clumsy. Others first notice that their walking has changed or that they are stumbling more frequently.
These symptoms are important because they may indicate that the spinal cord—not simply a nerve—is being compressed.
Cervical Myelopathy vs. Cervical Radiculopathy
Patients often hear the terms radiculopathy and myelopathy, but they describe different problems.
Cervical radiculopathy occurs when an individual nerve root in the neck becomes compressed or irritated. This can produce pain, numbness, tingling, or weakness traveling into one arm.
Cervical myelopathy involves compression of the spinal cord itself.
Because the spinal cord controls signals traveling to both the arms and legs, myelopathy can cause symptoms involving the hands, coordination, balance, and walking.
A patient can sometimes have both conditions at the same time.
How Is Cervical Myelopathy Diagnosed?
Diagnosis begins with a detailed history and neurological examination.
Your spine surgeon may evaluate:
Strength
Sensation
Reflexes
Hand coordination
Walking and balance
Signs of spinal cord dysfunction
Imaging is then used to evaluate the cervical spine.
MRI
An MRI is usually one of the most important tests because it allows the physician to see the spinal cord, discs, nerves, and surrounding soft tissues.
It can demonstrate where the spinal cord is being compressed and whether there are changes within the cord itself.
X-rays
X-rays can show the alignment of the cervical spine, arthritis, disc-space narrowing, instability, and bone spurs.
Flexion and extension X-rays may occasionally be used to determine whether abnormal movement occurs between vertebrae.
CT Scan
A CT scan provides excellent detail of the bones of the cervical spine and can be particularly helpful when evaluating significant bone spurs or conditions such as OPLL.
Does Cervical Myelopathy Always Require Surgery?
Not every patient with cervical stenosis requires surgery.
However, once a patient develops significant symptoms of spinal cord dysfunction, surgical treatment may be recommended to prevent further neurological deterioration.
The decision depends on several factors, including:
Severity of spinal cord compression
Neurological symptoms
Progression of symptoms
Number of spinal levels involved
Spinal alignment
Overall health
Findings on MRI, X-ray, or CT imaging
Unlike many causes of uncomplicated neck pain, cervical myelopathy deserves careful evaluation because spinal cord dysfunction can progress.
What Is the Goal of Cervical Myelopathy Surgery?
The primary goal of surgery is to decompress the spinal cord.
In other words, the surgeon creates more room for the spinal cord and removes or bypasses the structures causing compression.
Depending on the individual patient, surgery may be performed from the front of the neck, the back of the neck, or occasionally through a combination of approaches.
Possible procedures include:
Anterior Cervical Discectomy and Fusion (ACDF)
During an ACDF, the surgeon approaches the cervical spine through the front of the neck, removes the damaged disc and compressive material, decompresses the spinal cord and nerves, and stabilizes the spine with a fusion.
Cervical Corpectomy
A corpectomy involves removing part or all of a vertebral body along with surrounding discs when more extensive decompression is required.
Posterior Cervical Decompression and Fusion
For multilevel spinal stenosis, the surgeon may approach the spine from the back of the neck to create additional space for the spinal cord.
Instrumentation may also be used to stabilize the cervical spine.
Cervical Laminoplasty
In selected patients, laminoplasty can enlarge the spinal canal while preserving motion at several cervical levels.
The most appropriate procedure depends on the location of the compression, spinal alignment, number of affected levels, and the patient's individual anatomy.
Will Surgery Reverse the Symptoms?
Every patient is different.
Some patients experience significant improvement in hand function, walking, strength, or balance following spinal cord decompression.
Other patients may primarily experience stabilization of their neurological condition.
This is an important distinction.
When the spinal cord has been compressed for a long period of time, some neurological changes may not completely reverse. For this reason, the goal of treatment is often to relieve compression before additional spinal cord damage occurs.
Recovery can continue for months after surgery.
When Should You See a Spine Specialist?
You should consider evaluation if you are experiencing symptoms such as:
Increasing difficulty using your hands
Progressive arm or leg weakness
Frequent dropping of objects
Difficulty buttoning clothing
Problems with balance
Unexplained falls
Changes in your walking pattern
Numbness involving multiple extremities
Rapidly worsening weakness, severe difficulty walking, or new bowel or bladder dysfunction warrants urgent medical evaluation.
Early Recognition Matters
Cervical myelopathy is one of the more important conditions affecting the cervical spine because it involves the spinal cord itself.
Symptoms can initially be subtle. A patient may simply notice that handwriting has changed, buttons are becoming harder to fasten, or balance is not what it used to be.
If cervical myelopathy is suspected, a neurological examination and appropriate imaging can help determine whether the spinal cord is being compressed and what treatment options may be appropriate.
At Molina Spine, patients are evaluated individually to determine the cause of their symptoms and whether nonsurgical treatment, continued observation, or surgical decompression is appropriate.
If you are experiencing symptoms concerning for cervical spinal cord compression, schedule an evaluation to discuss your symptoms and imaging with a spine specialist.
Domingo Molina IV, MD, FAAOS
Orthopaedic Spine Surgeon
Molina Spine