What is cervical myelopathy?
Cervical myelopathy is a degenerative disease linked to the aging of our spine and is also a consequence of spondylosis and intervertebral cervical arthrosis . It causes a cervical spinal cord injury due to a spinal cord compression at the height of the neck.
In addition to the natural aging of our body, other causes can lead to this compression, such as inflammatory diseases, trauma and tumors.
People who suffer from cervical myelopathy have symptoms such as pain in the neck, shoulders, hands, legs and feet. Generally, swelling, severe pain and weakening of the muscles accompany these symptoms in the affected areas.
This is a disease without a definitive cure, but with specific treatments for each case. The professional responsible for treating these cases is the orthopedist, who must analyze in which situations the patient should resort to less invasive treatments, such as medications and physiotherapy, or when surgical procedures will be necessary.
Spondylosis, also known as cervical arthrosis, is a wear on the spine and occurs in the discs, which are a type of shock absorber for our body.
When they are damaged by this wear and tear, there is a decrease in the space between the vertebrae, which can cause osteophytes (parrot beaks) and severe pain. These nipples are bones that grow between worn discs. Consequently, it is one of the causes of cervical myelopathy.
As if it were a rod with a cylindrical shape, the spinal cord is 45 centimeters long and approximately 1 centimeter in diameter.
The spinal cord has two main functions in our body: nerve conduction and nerve center. Basically, this channel is fundamental for it to be possible to have sensitive functions, such as touch, pain or thermal sensations.
With its bundles of fibers, it carries nerve inflows so that all these sensations work well and this machine called the human body remains in order.
Spinal cord injuries can trigger several problems in addition to what happens in cervical myelopathy. Many of them are severe, such as paralysis, numbness and breathing problems.
Compression in the spinal cord can occur for different reasons and in different ways from case to case, being a sudden or gradual compression. Some of these factors are interconnected and manifest together. The main ones are:
Bones that are broken, dislocated or that have grown abnormally are some of the reasons that can lead to compression in the spinal cord. This bone deficiency, so to speak, can also appear due to the weakening caused by other diseases, such as cancer and osteoporosis . When faced with these circumstances, the bones can break because of minor trauma or even without any shock.
Bruises (accumulation of blood) can accumulate in or near the spinal cord and cause compression. This usually happens due to an injury, but it can also be caused by other clinical conditions, such as blood vessels with abnormal connections, tumors, use of anticoagulants, among others.
Pus, a thick, yellowish liquid that usually forms in infected wound sites, is also part of the factors that can cause compression in the spinal cord. Its accumulation outside the spinal cord – and in rarer cases within it – is responsible for damaging it.
They are caused by some cancer that has spread (metastasized) and settled near the spinal cord or into the surrounding space. The cases in which tumors cause compression are more rare, regardless of whether they are benign or malignant.
Herniated discs compromise the spinal nerve roots and the nerves near the spinal cord. The disruption that occurs in the discs thus causes compression and triggers some of the known symptoms of the disease, such as local pain.
Aging connective tissue
Aging connective tissue is one of the causes of cervical myelopathy because it also causes compression in the spinal cord. This is because this degeneration leads to an increase and stiffness in the tissues that line the spinal canal. Consequently, this causes the site to narrow and compress the spinal cord.
We can divide cervical myelopathy into two types: spondylotic cervical myelopathy and traumatic cervical myelopathy. Both affect the patient in the same way, but the causes are different.
Mielopatia cervical espondilótica
Spondylotic cervical myelopathy, in addition to being almost a tongue twister, is also quite common in offices, although it is not caused by trauma. This type of myelopathy is the result of a sum of degenerative problems.
In a way, everyone has some degree of this type of myelopathy when in adulthood and elderly, but not everyone develops as a pathology and has symptoms.
The main diseases linked to this degeneration are:
- Facet hypertrophy : It is the enlargement of the facet joint, that is, the connections of the posterior part of the adjacent vertebra. Among these connections, nerve roots are present;
- Hypertrophy of the yellow ligament (LA): This ligament is a structure of the spine that has the role of covering the lateral and posterior walls of the spinal canal. It maintains contact with nervous structures and its thickening, or hypertrophy, is one of the causes of the development of cervical spondylotic myelopathy;
- Osteophytes : Known as “parrot beaks”, they are bones that grow at the joint edges, between the discs already worn out. They cause severe pain in the place where they appear;
- Calcification of the posterior longitudinal ligament : Occurs when chronic inflammation affects a tendon or ligament. Our body tries to repair this inflammation, but ends up depositing calcium salts in the affected area, causing calcification (or ossification) of the area;
- Disc hernias : It happens when an external rupture causes a leak in the internal content of the discs, called the pulpy nucleus. This leak forms herniated discs and causes the symptoms of the disease.
Traumatic cervical myelopathy
Traumatic cervical myelopathy is a type of myelopathy that happens, obviously, after the patient goes through some trauma (tissue damage). It is directly linked to the cause, unlike cervical spondylotic myelopathy, caused by a degenerative process.
Many factors can lead to someone suffering a trauma, but they are almost always related to a serious accident.
These traumas are responsible for one of the causes of cervical myelopathy when the impact suffered by the patient is what caused the compression in the spinal cord.
Cervical myelopathy is not a disease exclusive to humans, it also affects horses. The name given to this specific type is stenotic cervical myelopathy (ECM) . Also called Wobbler or Bambeira Syndrome.
This is a disease that also happens due to compression in the cervical spine, due to stenosis (narrowing) of the spinal canal. It is common in all breeds of horses, but the breed that suffers most frequently is the English Thoroughbred, predominantly in males.
The signs of this spinal malformation appear when they are less than three years old. This is very early, even when we think of the average age of a horse: between 25 and 30 years old.
The diagnosis can also be made through radiographs. The animals, in these cases, presented symptoms such as lack of muscle coordination, spasticity – a disorder that causes muscle stiffness – and paralysis.
The treatment of horses with ECM includes changes in diet, rest, use of anti-inflammatories, vitamin E and selenium supplements , a mineral rich in antioxidants and which helps in the maintenance of blood vessels and blood circulation. In some cases, surgical interventions are also performed.
You already know that for cervical myelopathy to happen a compression occurs in the spinal cord. However, this compression may be the result of other factors, in addition to the natural aging of our body.
It is the natural cycle of things. People age and the body loses its rhythm and some functions may not be fully effective. It is so with our column.
Although cervical myelopathy is a disease with quite common changes in the human body, it is not yet known why the symptoms do not manifest in all patients.
What happens is the following: some diseases cause this compression in the spinal cord to happen. However, the compression is not always caused by some disease, as occurs in cases of compression by tumors or trauma. Understand:
Compression by trauma
In this situation, there is no risk group and there is no way to predict that cervical myelopathy will happen. Trauma to the spine is frequent and triggered by several reasons. The most common are traffic accidents (pedestrians and car accidents), falls, diving in shallow places and also by firearms.
These cases can have very serious damages, going beyond the compression in the medulla. Depending on the severity of the trauma and the affected vertebrae, the patient may lose partial body movements, or even not survive.
Another factor that can trigger the development of cervical myelopathy are tumors. They can be segmented into two types: primary and secondary.
When primary tumors are responsible for spinal cord compression, it means that these tumors originate in the spine itself, unlike secondary tumors. These come from other parts of the body, a process commonly known as metastasis. These tumors are the most frequent and usually malignant. The symptoms are very uncomfortable: in addition to pain in the spine, tumors can cause paralysis in the limbs (arms and / or legs), difficulty in evacuating and urinating.
The word tumor tends to scare and always carries that heavier air, but it is important not to despair and believe in the positive results. For example, in patients who need surgery, many advances in medicine help at this point.
There is a technique that helps in these cases, allowing to decompress the spinal cord and roots. In this way, they rebuild the column with the help of plates and screws. The vast majority of patients are released the next day to go home and rest.
Cervical disc hernias
A disk herniation the cervical rupture occurs when an outside its area causes a kind of leakage of internal contents, called the nucleus pulposus.
This pulpy nucleus then invades an area that should not be occupied by it and causes a compression of a cervical nerve root.
As they are responsible for conducting nerve impulses from one place to another, the roots become impaired by herniated discs and this compression causes the appearance of symptoms such as loss of sensation, tingling, pain and loss of strength.
Parrot beaks (Osteophytes)
Osteophytes, popularly known as ” parrot’s beak “, are wear and tear that occur in the spine. It is more common in the elderly and is among the causes of cervical myelopathy.
What happens is the following: the discs, a type of buffer between the vertebrae, are already wearing out. These ‘parrot beaks’ appear as a response from our body to try to make up for this deficiency. They are bones that grow at the joint edges, on the side or the front of the discs, causing so-called marginal osteophytes.
This does not work very well, as is already known. The main symptom is pain in the area, which can trigger acute crises. Treatment is carried out with medications or injections to relieve pain, in addition to physical therapy to help correct muscle problems.
The development of rheumatoid arthritis can trigger several complications, in addition to myelopathy. Some examples are injuries to the joints and even tendon rupture.
The arthritis rheumatoid is basically an inflammation of the synovial membranes, or the thin layer of connective tissue lining the joints. They produce synovial fluid, which is responsible for nourishing and lubricating the joints. When the inflammation occurs, it does not and the damage appears.
In the case of myelopathy, it is the cervical region that is harmed by this. Inflammation causes pressure on the joints and, consequently, stimulates compression in the spinal cord, in addition to enabling other deformities.
This disease can occur at any age, but it is more common in middle-aged adults and in females.
Transverse myelitis is an autoimmune disease that can also be caused by other diseases. It feels like a domino effect of bad things happening to your spine.
Basically, an inflammation occurs and affects the spinal cord across its width, in a transversal way, which gives the name myelitis transversal to the disease. As it happens in this way, the inflammation ends up blocking the transmission of nerve impulses that travel from top to bottom in the spinal cord, which leads to compression.
As in the case of patients with cervical myelopathy, transverse myelitis also presents symptoms such as severe pain at the site. Generally, the person with myelitis will feel a tightness, but in severe cases the disease can even cause paralysis.
“Stenosis” means narrowing. Thus, cervical stenosis is the result of conditions of the diseases that cause cervical myelopathy. These two injuries are linked together, as they undergo the same process. The difference is that myelopathy is the compression and degeneration of the spinal cord, while stenosis is the progressive decrease in the diameter of the spinal canal, where the spinal cord and nerve roots pass.
Naturally, because it is a degenerative disease, cervical myelopathy affects mainly elderly people . The compression that the spinal cord undergoes is the result of wear and tear suffered over the years, which is why it is so common in people over 50 years old.
Cervical myelopathy is not transmissible . It is a chronic, non-contagious degenerative disease. The causes that lead to its development, although diverse, do not transmit the disease.
According to the Nurick system, created to assess the severity of cases of cervical myelopathy, there are 6 levels of the disease. These levels are classified from 0 to 5 and correspond to the patient’s characteristics at a certain stage. Are they:
In this degree, the patient has symptoms and signs that the nerve roots that leave the spinal canal have been affected, but without conclusions that the spinal cord itself has suffered any damage.
He presents symptoms of the disease in the spinal cord, but still does not show difficulties to walk.
During level 2, the patient diagnosed with cervical myelopathy has mild difficulties in walking, but that does not prevent him from maintaining day-to-day activities.
This level is the evolution of the previous table. Here, the patient has great difficulty in walking, requiring help to perform this activity. Doing everyday tasks is also more difficult.
Possibly, the patient will be instructed not to maintain a full-time occupation, thus having to leave work or other daily tasks.
In such cases, the patient is already in an advanced degree of the disease. To walk, you need help from other people or a walker.
It is the most serious level in the Nurick system. Unfortunately, when the patient with myelopathy reaches this stage of the disease, it is necessary to resort to a wheelchair.
Cervical myelopathy has some general and other more specific symptoms in more aggravated situations, such as trauma and tumor myelopathy. Among the main signs that should appear, are:
- Neck pain;
- Stiffness, especially in the legs (hypertonia);
- Balance problems;
- Sensation of numbness in the hands, arms and legs;
- Sensory and reflex loss;
- Loss of muscle strength;
- Loss of thermal sensitivity;
- Urinary incontinence (some cases).
In addition to these symptoms, the patient may experience neurovegetative changes , which are manifested, for example, in the difficulty of retaining or expelling urine (urinary incontinence). This means that the disease has damaged the nervous system, as it is responsible for controlling the urine.
Shock, tingling and burning sensations in the upper limbs can also arise as symptoms of myelopathy.
It is possible to obtain a diagnosis of cervical myelopathy in different ways. Some are known, but others are very specific and differentiated. Get to know:
This exam is very common to identify injuries. It is important because it allows a more precise visibility of the internal structure, the curvature of the spine and the spondylotic process, that is, the pathology that causes the reduction of the spinal canal.
Magnetic resonance imaging is an exam capable of creating high definition images using the magnetic field. This is because the agitation of the molecules is transmitted to a computer prepared to decode this image. It may seem complicated, but it is simple.
The patient will not be damaged by this examination, he will only have to take minimal care, such as avoiding jewelry and metallic objects, due to the power of the magnetic field. During the exam, the individual enters a kind of tube and must remain immobile, so as not to harm the final result of the diagnosis.
Computed Axial Tomography (CAT)
Tomography has a process very similar to that of radiography (X-ray), but with a very important advantage. The difference between these two tests is in the quality of the tomography.
With greater precision, it allows for a better analysis of injuries, fractures or even very small and imperceptible tumors on radiography. In addition, it allows for several cuts for analysis, while X-ray only allows a more punctual diagnosis.
In the case of myelopathy, this examination reveals the existence of disc calcification, ligaments, hypertrophy of the articular facets and also the presence of osteophytes.
Neurophysiological examinations are part of a science that delves into analyzes of the nervous system and its functioning: neuroscience.
When used in cases of cervical myelopathy, they have the role of assessing whether there is any involvement of the spinal cord or nerve roots. This procedure is fundamental to what is called a differential diagnosis.
This “differential diagnosis” aims to search for alternative causes for the disease, such as tumors, demyelinating diseases, occipito-cervical transition pathologies, neurodegenerative diseases and infections.
Myelopathy is treated and, when diagnosed in time, can be reversed . Because it is a degenerative and chronic disease, it often becomes progressive.
Some patients suffer from milder and more transient symptoms, but the vast majority tend to have more acute attacks. The procedures performed during treatment allow the symptoms to stabilize, relieving pain and providing well-being.
Cervical myelopathy is a disease with some treatment possibilities. There are some studies with new ways to relieve the pain of those who go through this problem and more conventional ways of treating it. They are divided into two categories: conservative treatment and surgical treatment.
Conservative treatment does not have that name because it is related to an old-fashioned way of taking care of this problem. The term conservative is used to preserve the patient. There are some procedures to relieve symptoms and even prevent the onset of cervical myelopathy before it becomes something reversible with surgical treatment alone.
In the treatment carried out with medications, the use of anti-inflammatory drugs is indicated to help with pain and inflammation. Corticosteroids are also used to reduce swelling.
External immobilization: cervical collar
The cervical collar is a form of auxiliary treatment, so to speak. He is responsible for immobilizing the injured area and prevents the condition from getting worse.
However, the orthopedic doctor will know when the use will be necessary or not. In some cases, exercise and physical therapy will be more beneficial than leaving the injured area immobile.
Physiotherapy is a treatment that goes beyond a one-off case. It is possible that physical therapy in order to help reduce the symptoms of cervical myelopathy will also solve problems in other areas of the body.
The techniques used in physiotherapy involve mechanical restructuring by postural corrections and non-invasive decompression techniques.
This is a procedure used to relieve compression in the spine. In it, what is causing the pressure is removed, like the parrot’s beaks. The function of surgery is to intervene when no other less invasive treatment has been successful.
In this surgery, the doctor will make an incision (cut) in the back of the neck or in the middle of the spine to remove what is causing the compression. The procedure takes between 1 and 3 hours.
During this time, the patient will be under anesthesia, being able to choose general anesthesia, where he will sleep for the entire time he is in the operating table, or staying awake with the option of spinal anesthesia (anesthesia commonly used in cesarean sections).
In some cases, a vertebral fusion also occurs. This means that two or more bones in the spine are connected. The goal is to provide greater stability for the spine. Another possible procedure is foraminotomy , in which the area through which the nerve roots pass is enlarged.
Laminectomy does not cause pain to the patient, who must follow some procedures recommended by the doctor, such as resting and avoiding physical efforts. In addition, using moisturizing creams, swimming pools and bathtubs should be avoided, due to the risk of infections in the area.
One of the treatments for cervical myelopathy involves spinal cord decompression through this procedure called arthrodesis, in which a bone fusion is made in a joint and causes immobility. Arthrodesis can be performed both in the cervical, thoracic and lumbar regions.
In many pathologies this resource is used, as it helps in recovering the stability of the spine. Surgery for arthrodesis may require special materials such as screws, bars and plates for fusion, but what causes fusion, in fact, is the placement of grafts at the site injured by the disease.
Despite being a surgery and seeming to be aggressive to the patient, the process tends to be less invasive than you think. For this procedure, the incisions made in the skin are small.
Like laminectomy, arthrodesis is a plan B procedure. It should be used when conservative treatments have been used without success. In such cases, the patient must undergo surgical treatments to relieve the disease and symptoms.
Risks of myelopathy surgery
Surgical treatments in patients with cervical myelopathy can present some risks, such as infections, bruises, spinal cord injuries and dural injury – when there is a wound in the “sac” that surrounds the spinal nerves.
Other injuries associated with the surgical procedure are difficulties in swallowing, which can affect between 10% to 30% of patients, voice alteration, inadequate placement or deviation of implants, esophageal injury and pain at the graft site and between vertebrae.
Despite the list of risks that can occur, fortunately, the procedures have very low numbers of complications.
Like any other surgery, it is very important to maintain rest and to gradually return to daily activities. Surgery for cervical myelopathy is not a high-risk procedure and the number of complications is low.
Probably, the use of the cervical collar will be necessary. It is normal for the prescription to recommend use for 4 or 6 weeks. Practicing some light activity can also help in this recovery, such as walking in small periods and low intensities, with progressive increase.
Physiotherapy begins when the use of the cervical collar ends. Within 4 to 6 weeks after the operation, it is possible that the orthopedist will recommend physical therapy to regain strength and balance.
The patient will, in fact, have to be a patient. The intervertebral fusion, correction made in the surgery, will only be complete after 3 months. However, recovery takes place gradually, and in some cases, it may stabilize only around 1 year after the procedure.
Cervical myelopathy presents some risks related to the lack of adequate treatment or even surgical complications.
Thinking about complications even before a surgical treatment itself, some people usually experience difficulty in swallowing, voice changes, pain in the area where the graft was extracted (in some cases part of the hip bone is used), damage to the esophagus and complications of implants , when misplaced.
- Non-steroidal anti-inflammatory drugs;
- Rituximab , when the cause is autoimmune;
- Ibuprofen , when the cause is cervical spondylosis;
- Baclofen , in cases of muscle spasms.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Change. When we think of living with some pathology, the word change always appears, sooner or later. And, like it or not, it is for the good that it arises. Believe it.
Cervical myelopathy, as we already know, is chronic, degenerative, can be progressive and be caused by other pathologies. The symptoms are not at all legal. However, the treatments are varied and help the patient to get away from the disease, pain and return to having a minimally comfortable life. Which is – now it is – a lot cooler.
If you are living with it, have already lived with the disease, or have someone close to you experiencing this condition, or just try to find out more about the pathology, take the opportunity to know some tips to make the daily lives of these patients with more quality of life.
Ask your questions with the specialist doctor
Do not wait for the symptoms to get worse, do not think that pain is normal or that you are part of age. Don’t self-medicate, either. The most important thing when we are facing a health problem is to know from the specialist professional what is happening to our body and how it can be solved.
Before any problems even arise, visit the doctor and keep some care with yourself. Healthy habits and preventive thoughts help.
The Pilates can be a great ally in the coexistence with cervical myelopathy and other pathologies. The set of exercises established in practice enables muscle strengthening, improves posture, in addition to providing a moment of well-being and relaxation.
Together with physiotherapy and basic care with diet and healthy habits, pilates will play a fundamental role in the recovery of the cervical spine.
Yoga is an exercise that provides physical benefits, but it positively affects the mind as well. Facing a disease that causes such uncomfortable pain and symptoms is not easy. In such cases, performing an activity that also relieves stress can be one of the most rewarding options.
Like pilates, it also helps to strengthen muscles. Other benefits of yoga are improved concentration, weight loss and increased sleep quality.
One question that may arise among patients with cervical myelopathy is about disability retirement. It is possible when the condition of the disease prevents the person from exercising their profession or is also unable to be rehabilitated in another function. This is how the INSS medical expertise assessment works.
First, what will be requested is a sickness benefit, with the same requirements. According to the medical expert, if it is assessed that the patient will have this permanent incapacity for work, the indication will be to move on with retirement.
The benefit has some periodic evaluation procedures and the beneficiary will have to attend exams every 2 years to prove his disability. However, with people over 60, it is different: there is no such requirement for exams, as guaranteed by Law no. 13,063 / 2014.
Because it is a degenerative disease, caused by other diseases and even trauma, prevention is a more difficult process. What you have are some ideas about what could be done to try to avoid it. Simple and basic things like preventing tensions and accidents. Some tips are:
At home or at work
It is silly, but even maintaining a correct posture when standing and crouching to reach an object is a way of caring for our spine. You may already know this by heart, but it is worth the reinforcement.
When you are at work, if you have a routine of moving heavy loads or gross physical efforts, try to pay attention to the way in which these activities are being carried out.
For people who spend most of their time sitting, it is essential to maintain an upright and comfortable posture, without overloading the spine. Stretching and physical exercises, such as walking, are welcome for everyone.
Some people, before being diagnosed with cervical myelopathy, already have symptoms that may precede the disease, such as herniated discs. In such cases, the practice of contact sports, such as football, should be avoided so as not to cause complications and intensify symptoms, such as severe pain in the area and possible trauma to the spine by the impact of the activity.
Inside our homes, some changes can prevent major accidents, especially for the elderly, who are part of the risk group. Some tips on what can be done or avoided:
- Avoid carpets or any obstacle on the floor;
- Have lighting on stairs and close to the bed, to avoid falls due to lack of visibility;
- Install grab bars in bathrooms, next to the shower and toilet;
- Avoid sudden movements when lifting when lying or raised.
Aging is inevitable and accidents happen, but we can try to mitigate the effects of the predictable and the unpredictable. Despite being a degenerative disease, cervical myelopathy is treated and the patient can have a comfortable life. Especially when the diagnosis is made in advance.
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