Cervical Myelopathy: Symptoms, Diagnosis, and Treatment
What Is Cervical Myelopathy?
Cervical myelopathy occurs when pressure on the spinal cord in the neck begins to affect its normal function.
The spinal cord carries important signals between the brain and the rest of the body. When it becomes compressed, these signals may be disrupted, affecting strength, balance, coordination, and walking.
The most common cause is age-related wear and tear of the spine. Over time, bulging discs, bone spurs, and thickened ligaments can narrow the spinal canal and place pressure on the spinal cord.
This condition is called degenerative cervical myelopathy.
Unlike many causes of neck pain, cervical myelopathy involves the spinal cord itself. Recognizing and treating this condition is important because neurological function can gradually worsen over time.
What Are the Symptoms?
Cervical myelopathy often develops gradually, and its early symptoms can be subtle. Patients may notice changes in activities that previously seemed effortless.
Common symptoms include:
- Difficulty with balance or walking
- Clumsiness or loss of coordination in the hands
- Trouble buttoning shirts, writing, or handling small objects
- Frequently dropping objects
- Numbness or tingling in the hands
- Weakness in the arms or legs
- Increasing difficulty climbing stairs or frequent falls
Some patients experience neck pain or stiffness, while others have little or no pain at all.
Because symptoms often develop slowly, patients may initially attribute these changes to aging or arthritis.
Difficulty using your hands or maintaining your balance should not automatically be considered a normal part of aging.
How Is Cervical Myelopathy Diagnosed?
Diagnosis begins with a careful discussion of your symptoms and a neurological examination.
Your physician will assess your strength, sensation, reflexes, balance, and coordination to identify signs of spinal cord dysfunction.
An MRI of the cervical spine is particularly important because it allows us to see the spinal cord and determine whether compression is present.
X-rays may also be obtained to evaluate the alignment and stability of the cervical spine.
Importantly, spinal cord compression on an MRI does not always mean a patient has myelopathy.
The diagnosis depends on whether the spinal cord is being affected, not simply how narrow the spinal canal appears on imaging.
Can Cervical Myelopathy Get Worse?
Cervical myelopathy can progress over time, although the rate of progression varies between patients.
Some individuals experience gradual changes over several years, while others notice a more rapid decline in strength, balance, or hand coordination.
In certain cases, neurological function may remain relatively stable for a period before worsening.
Unfortunately, damage to the spinal cord may not be fully reversible.
This is why recognizing symptoms early and determining whether surgery is appropriate can be important for preserving long-term neurological function.
When Is Surgery Recommended?
Unlike conditions that primarily cause neck or arm pain, cervical myelopathy often requires surgical treatment.
For patients with moderate or severe myelopathy, surgery is generally recommended to relieve pressure on the spinal cord and reduce the risk of further neurological decline.
Patients with mild myelopathy may be candidates for surgery or a closely supervised trial of nonsurgical treatment. If neurological function worsens or fails to improve, surgical treatment should be reconsidered.
However, nonsurgical treatments cannot physically remove the pressure on the spinal cord.
The primary goal of surgery is to prevent further neurological deterioration, while also giving the spinal cord an opportunity to recover.
Can Surgery Improve Neurological Function?
Yes. Many patients experience meaningful improvements in neurological function following surgery.
Patients may notice better balance, improved walking ability, greater hand coordination, or increased strength.
Clinical studies have demonstrated improvements in physical function and quality of life following surgical treatment for degenerative cervical myelopathy.
However, recovery varies between patients.
The severity of spinal cord dysfunction, the duration of symptoms, and the patient’s overall health can influence the degree of improvement.
Some patients experience substantial recovery, while others may have lasting symptoms despite successful surgery.
Although surgery cannot guarantee complete neurological recovery, it can provide a valuable opportunity to preserve function, improve independence, and prevent further decline.
What Does Surgery Involve?
Surgery focuses on creating more space for the spinal cord by removing the structures causing compression.
Several procedures may be considered depending on the location of compression, the number of affected levels, and spinal alignment.
An anterior cervical discectomy and fusion (ACDF) removes a damaged disc and other structures pressing on the spinal cord before stabilizing the affected level.
When multiple levels are involved, procedures performed from the back of the neck, such as a laminectomy or laminoplasty, may be appropriate. Some patients also require spinal fusion.
The choice of surgery is individualized to safely relieve spinal cord compression while maintaining appropriate spinal alignment and stability.
As with any operation, there are potential risks, and the expected benefits must be considered carefully.
When Should You Seek Medical Attention?
New difficulty with balance, worsening hand coordination, or progressive weakness should be evaluated promptly.
Rapidly worsening weakness, sudden inability to walk, or new loss of bowel or bladder control requires immediate emergency evaluation.
Early evaluation is particularly important when symptoms suggest spinal cord dysfunction.
My Approach to Spine Care
My approach begins with understanding how spinal cord compression is affecting a patient’s neurological function and daily life.
Not every patient with cervical stenosis requires surgery. However, when spinal cord dysfunction develops, the decision to operate becomes particularly important.
I believe patients should understand both the potential benefits of surgery and the limitations of neurological recovery.
When surgery is appropriate, my goal is to safely relieve pressure on the spinal cord, preserve neurological function, and provide the best opportunity for meaningful recovery.
Ultimately, successful treatment is not simply about improving an MRI. It is about protecting a patient’s ability to remain active, independent, and engaged in everyday life.
Medical References
1. American Academy of Orthopaedic Surgeons (AAOS). Cervical Spondylotic Myelopathy (Spinal Cord Compression). OrthoInfo.
2. Fehlings MG, et al. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine Journal. 2017;7(3 Suppl):70S–83S. doi:10.1177/2192568217701914.
3. Fehlings MG, et al. A Global Perspective on the Outcomes of Surgical Decompression in Patients With Cervical Spondylotic Myelopathy: Results From the Prospective Multicenter AOSpine International Study on 479 Patients. Spine. 2015;40(17):1322– 1328. doi:10.1097/ BRS.0000000000000988.