Cervical Spondylosis with Myelopathy

Cervical spondylosis with myelopathy (CSM) occurs when the spinal cord is impaired by progressively deteriorating changes in the neck. The changes occur in the facet joints and the discs along the spinal cord. This condition usually affects individuals over the age of 50, but can occur in younger patients if the compression and narrowing of the spinal cord is significant. This dysfunction, also called myelopathy of the spinal cord can be debilitating to those inflicted.

Causes of Cervical Spondylosis with Myelopathy

As we age, our spine naturally deteriorates from the normal wear and tear of everyday life. Cervical spondylosis, often referred to as arthritis, occurs when the disks in our spine start to degenerate. It is a process which happens to everyone. Some people will experience discomfort as they hit middle-age but many will have no pain at all.

1. Bone Spurs

As we age, our spinal disks shorten and get fatter. This causes them to get stiff and dry out. Lots of disk space and disk height is lost due to settling. When this occurs, the vertebrae in your back get too close together. In order to strengthen the weakened area, your body creates more bone around the affected disks. This causes a condition called bone spurs. Bone spurs make your back stiff and can compress the spinal cord, which may lead to considerable discomfort.

2. Herniated Disk

A herniated disk occurs when a disk's center is pushed to its outer edges by activities like bending, lifting and pulling. The gel-like substance can squeeze completely through if the disk is injured or significantly deteriorated. If it pushes on the spinal canal, it can cause pressure on nerve roots. When we age, we are more susceptible to herniated disks associated with cervical spondylosis with myelopathy.

3. Other Causes

An autoimmune disease called rheumatoid arthritis can lead to cervical spondylosis. It can cause discomfort, stiffness and pain. In severe instances, it can cause damage to facet joints located in the cervical spine.

CSM can also be caused by a neck injury, resulting from a sports activity, a car accident or falling down.

Symptoms of Cervical Spondylosis with Myelopathy

A wide variety of symptoms may appear. The first symptom is a change in the way a person walks. An individual may develop a spastic gait, causing him to walk stiffly and even drag his toes. The next sign is usually numbness in the hands and arms, as well as diminished fine motor skills.

Other signs and symptoms include:

  • Weakness or diminished fine motor skills in all or any extremities
  • Loss or compromised sensory abilities of lower extremities
  • Pain in shoulder or neck
  • Difficulty walking with a proper gait
  • Bladder and bowel dysfunction
  • Low reflex response in upper extremities
  • Degeneration of spinal area and extremities

Diagnosis of Cervical Spondylosis with Myelopathy

The first step to diagnosing myelopathy of the spinal cord is an examination by your doctor. First, you will discuss your general medical history and your current symptoms. Next, your doctor will examine your arms, shoulders, neck, legs and hands for signs of:

  • Reflex changes, either diminished or overactive
  • Loss of balance or difficulty walking
  • Weakness and numbness in hands, arms and fingers
  • Deteriorating muscles

If your doctor deems it necessary, the following tests will be ordered:

  • X-rays to provide a clearer picture of how your neck vertebra is aligned
  • MRI scans to reveal if there is a herniated disk or spinal cord compression
  • CT scans in order to assist your doctor in determining if there is a thinning spinal canal or bone spurs on your spine
  • Myelograms with contracting dye to reveal if there is any damage to spinal nerve roots

Treatments for Cervical Spondylosis with Myelopathy

The severity of your condition will determine your treatment options. Sometimes your doctor can treat it with medications, but at other times surgery may be necessary.

1. Medications

If your symptoms are mild to moderate, your condition may be managed through medication. Anti-inflammatory drugs, muscle relaxants, and other pain relieving medications can be used to treat the disease and its symptoms. Antidepressant and anticonvulsants drugs may be prescribed to treat neuropathic pain associated with spinal-cord and nerve-root compression.

2. Physical Therapy

When you are strong enough, you will need to go to physical therapy so that you can learn how to perform daily activities without hurting yourself. Also, you will be taught how to move correctly, increase your flexibility, and strengthen your neck and back muscles without reinjuring yourself.

3. Surgery

Surgery for cervical spondylosis with myelopathy is designed to alleviate symptoms, stop the progression of the condition and hopefully restore any lost function. The first goal is to relieve any decompression on the spinal cord. Once that is accomplished, a spinal fusion process is done to stabilize spinal bones and other neural elements.

There are two ways to achieve decompression, the discectomy or laminectomy approach. One or both methods can be utilized, but no matter the case, a re-stabilization procedure must be completed to correct the damage done. This process is referred to as a spinal fusion. To complete the process, bone is usually removed and medical hardware such as rods, screws and cages are inserted to achieve stability.

4. Soft Cervical Collar

After surgery, your doctor will advise you to use a soft cervical collar. The collar is padded and surrounds your neck. It is designed to limit your neck’s range of motion and let your muscles rest. However, it is important to note you should not use it past the time your doctor or surgeon recommendations as your neck muscles will lose their strength with long term use.

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