Cervical myelopathy - a Cause of Numbness and weakness

What is cervical myelopathy?

Cervical myelopathy is a type of spinal cord compression caused by a narrowing or stenosis of the spinal canal at the neck.

The spinal cord is made up of large bones called vertebrae that stack on top of one another and are separated by spinal discs. They overlap at the back to form facet joints and together the vertebrae form a channel, the spinal canal, through which the spinal cord runs. This canal is normally comfortably wide enough to allow the spinal cord plenty of room.

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Vertebra showing the spinal canal which can become smaller with cervical spinal stenosis and may lead to cervical myelopathy

 

 

 

Anything that causes a reduction in the amount of space available to the spinal cord can cause cervical myelopathy. However, there are some common causes:

Cervical spinal stenosis 

Not all spinal stenosis causes cervical myelopathy, many people have spinal canal stenosis and don’t have serious problems, it only becomes a worry if the spinal cord becomes compressed leading to changes in the nervous system.

As we get older it is very common to get changes of age in the neck. These occur normally but in some people the process can cause unwelcome problems. As we age the body will often form new bone to compensate for a lifetime of use. These new bony growths are called osteophytes and they try to increase the stability of the area. Sometimes though, these osteophytes can creep into the space needed by the spinal cord and not leave it enough room. This can be worsened by a stiffening of the ligaments in the neck and occasionally by movement of one vertebra on another – called cervical spondylolisthesis.  Further problems can be caused by disc bulges. This narrowing of the spinal canal is called cervical spinal stenosis, in severe cases this can lead to the spinal cord becoming squashed.

Cancer of the spine and other more serious spinal cord diseases

Less commonly cancer of the spine or spinal cord tumours can also cause a reduction in space and a compression of the spinal cord leading to cervical myelopathy.  Infections and trauma can also lead to this condition. Go and see your doctor if you are at all worried and they will assess you to make sure you have a proper diagnosis.

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What are the symptoms of cervical myelopathy?

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It depends on how much the spinal cord is compressed and which part of it affected.  Unless there has been trauma or some other dramatic event the symptoms usually creep up on you. It is more normal for cervical spinal stenosis symptoms to gradually build up.
The main symptoms are weakness and numbness in the arms and/or legs.  This may show itself as:

• Difficulty with normal walking because of a sense of the legs not feeling right – patients describe the sensation as feeling as if their legs didn’t belong to them
• Difficulty with finger dexterity – doing up buttons and writing may become a problem
• Twitching and jumping of the arm or leg muscles
• There may be pain in the arms if a nerve root is affected

Diagnosing Cervical Myelopathy

You must go and see a doctor for an assessment

• Your doctor will take a full history and will ask lots of questions about the type of symptoms you have got, how long you have had them and what they feel like.
• The doctor will also ask questions about your general health and fitness and will check to make sure you have nothing worrying in your medical history.
• A neurological physical examination will look for changes in sensation, alterations to your muscle power and changes to your reflexes.
• The doctor may also order other investigations such as an X-ray or more commonly an MRI scan which will show if the spinal canal is reduced and the spinal cord is being compressed.

Cervical Myelopathy can be a very serious condition – it needs immediate medical attention for evaluation and may need cervical stenosis surgery to increase the space for the spinal cord and stabilise the area.  It is essential that spinal cord tumours, infection and fractures are ruled out urgently.  If you have any symptoms suggestive of this problem you must seek urgent medical assessment.

What is the difference between this and sciatica or peripheral neuropathy?

The symptoms differ from symptoms of sciatica and peripheral neuropathy in several ways.

Sciatica affects one or more nerve roots as they leave the spinal cords. Usually only one side is affected and so weakness, pain and numbness and tingling is usually only felt in one leg or foot. The sensory changes are more or less in a recognisable pattern or strip depending on the level of the nerve root involved.
Peripheral neuropathy, including diabetic neuropathy, tends to show as more of a sock or stocking distribution. You can see an example of peripheral neuropathy sensory changes on this page.

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02-Mar-2015