Spine-Related Musculoskeletal Conditions – Part 7 – Myelopathy

In this series, we have been reviewing spine-related musculoskeletal conditions that are frequently seen in dentists and surgeons.  In this post, we will be looking at myelopathy.

Myelopathy

Definition: Myelopathy is damage to the spinal cord caused either by a traumatic injury or a chronic musculoskeletal condition. The term myelopathy generally refers to damage to the spinal cord, but may be used in reference to a handful of specific conditions, including:

  • Cervical Spondylotic Myelopathy: This is by far the most common form of myelopathy and involves the compression of the spinal cord in the cervical spine (neck). We will discuss cervical spondylotic myelopathy further below.
  • Thoracic Myelopathy: This occurs in the middle region of the spine. Typically, the spine gets compressed due to bulging or herniated discs, bone spurs, or spinal trauma.
  • Lumbar Myelopathy: This is a rare condition because the spinal cord typically ends in the upper section of the lumbar spine; however, the if the spinal cord is low-lying or tethered, it can be affected by this condition.

Cervical Spondylotic Myelopathy

Overview:  Cervical spondylotic myelopathy is damage to the spinal cord due to spinal degeneration, most commonly in the form of spinal osteoarthritis. As the spinal cord is compressed (spinal stenosis) due to inflammation and osteophytes, it can cause damage to the spinal cord and lead to an array of neurological symptoms.

Causes:  As discussed above, the inflammation and bone spurs (osteophytes) common to spinal osteoarthritis can exert pressure on the spinal cord and cause damage.  Bulging and herniated discs and thickened ligaments can also contribute to myelopathy.  In rarer cases an acute, traumatic injury to the neck can result in myelopathy.

Symptoms:  Numbness, weakness, and/or tingling in the hands or arms, loss of balance, stiffness in the legs, and urinary urgency.

Diagnosis: A CT scan with a Myelogram is used to reveal indentations in the spinal fluid sac.  In this procedure an opaque dye is injected into the spinal canal prior to the CT scan to create contrast and provide images of the spinal canal.  This is done in conjunction with an MRI, which provides imaging of the spinal cord and nerve roots, as well as the intervertebral discs and spinal ligaments.

Treatment: Surgery to decompress the spinal cord and prevent further damage is the most common treatment for cervical spondylotic myelopathy.  The precise nature of the surgery varies and depends on the severity of the condition and its location.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

1. Spine-health, https://www.spine-health.com/.
2. Mayo Clinic, http://www.mayoclinic.org/.
3. The Neurological Institute of New York,
http://columbianeurology.org/about-us/neurological-institute-new-york.
4. John Hopkins Medicine, http://www.hopkinsmedicine.org/.
5. WebMD, http://www.webmd.com/.