Myelopathy
All about the causes, symptoms, and the most effective treatments for spinal cord injuries.
Symptoms and Causes
Myelopathy refers to diseases affecting the spinal cord and may involve either injury or dysfunction.
Depending on the location of the pathology, myelopathy is classified into three types:
- Cervical myelopathy: affects the neck area (cervical region).
- Thoracic myelopathy: occurs in the mid-back (thoracic region).
- Lumbar myelopathy: develops in the lower back (lumbar region).
The prognosis of myelopathy varies depending on severity and duration of the disease. Early diagnosis is essential to initiate timely treatment and prevent complications.
Symptoms
Symptoms of myelopathy develop gradually as the disease progresses. The most characteristic include:
- Tingling in the hands or feet.
- Difficulty performing daily activities (walking, writing, buttoning clothing).
- Reduced range of motion.
- Lack of coordination, unsteady gait.
- Balance problems.
- Muscle weakness.
- Pain in the back, limbs, or neck.
- Muscle cramps.
- Difficulty moving the neck.
Causes
Myelopathy may result from different causes and is therefore divided into several types:
- Compressive myelopathy: the spinal cord becomes compressed due to:
- Trauma.
- Vertebral fractures.
- Spinal stenosis: narrowing of the spinal canal.
- Herniated disc: displacement of an intervertebral disc.
- Spondylosis: degeneration of the intervertebral discs or vertebrae.
- Demyelinating myelopathy: deterioration of the myelin sheath surrounding nerve cells, commonly caused by:
- Autoimmune disorders, such as multiple sclerosis.
- Infections (tuberculosis, HIV, abscesses).
- Inflammatory diseases.
- Vascular myelopathy: reduced blood flow to the spinal cord due to:
- Vascular malformations.
- Vasoconstriction: narrowing of blood vessels.
- Toxic myelopathy: caused by exposure to toxic agents such as medications, anesthetics, or chemical substances.
- Metabolic myelopathy: associated with vitamin B12 deficiency.
- Paraneoplastic myelopathy: results from an immune response to a tumor, even if it is located elsewhere in the body.
Risk Factors
The risk of developing myelopathy is higher in the following situations:
- Age: vertebrae and intervertebral discs degenerate over time.
- Degenerative diseases, such as spondylosis, herniated disc, or spinal stenosis.
- Spinal trauma leading to loss of vertebral alignment.
- Autoimmune diseases, such as rheumatoid arthritis or multiple sclerosis.
- Tumors exerting pressure on the spinal cord.
- Spinal infections.
- Radiotherapy.
- Exposure to toxic substances.
Complications
If myelopathy is not treated in time or does not respond adequately to treatment, it may lead to severe complications, including:
- Loss of mobility.
- Impaired fine motor skills.
- Muscle stiffness.
- Spasticity: involuntary muscle movements.
- Balance disturbances and increased risk of falls.
- Lack of coordination.
- Muscle atrophy.
- Incontinence (loss of sphincter control).
- Difficulty breathing or swallowing.
- Chronic pain.
Prevention
Although myelopathy cannot always be prevented, the following measures are recommended:
- Maintain proper posture, both while sitting and during physical exertion.
- Follow ergonomic guidelines in the workplace.
- Maintain a healthy body weight.
- Engage in regular strength and flexibility exercise.
- Avoid smoking.
- Prevent spinal trauma whenever possible.
Which doctor treats myelopathy?
Myelopathy is managed within the specialties of neurosurgery and traumatology and orthopedic surgery.
Diagnosis
Diagnosing myelopathy is complex and may take time. The procedures required to confirm the condition include:
- Medical history: assessment of the patient’s medical and family history, symptoms, and their progression.
- Physical examination: performed to detect muscle weakness, stiffness, and pain points.
- Imaging studies: magnetic resonance imaging (MRI), which uses radio waves and a magnetic field, or computed tomography (CT), which uses X-rays, provide detailed visualization of the spine to assess its structures and detect abnormalities, compression, cysts, tumors, or fractures.
- Lumbar puncture: cerebrospinal fluid is collected using a needle and analyzed for signs of inflammation, infection, or neurological disorders.
- Blood tests: to rule out metabolic causes (vitamin B12 deficiency).
- Electromyography (EMG): surface electrodes are placed on the skin to detect possible neurological and/or muscular damage.
Treatment
Treatment of myelopathy depends on patient characteristics and the specific type of disease. The primary goal is to relieve pressure on the spinal cord using various approaches:
- Decompression surgery: may be performed via an anterior approach (through an incision at the front of the neck) or a posterior approach (from the back of the neck). The chosen procedure depends on individual case requirements:
- Discectomy: removal of the damaged disc.
- Corpectomy: removal of the entire vertebral body.
- Laminectomy: removal of part of a vertebra.
- Laminoplasty: reshaping of the vertebra to create more space for the spinal cord.
- Stabilization surgery: often required after decompression to ensure spinal stability and prevent further spinal cord damage. It involves fusion of several vertebrae using plates and screws and is usually performed during the same surgical procedure as decompression.
- Physiotherapy: therapeutic exercises and manual therapy help strengthen muscles, improve coordination, and relieve symptoms.
- Medications: analgesics are used to relieve pain, and anti-inflammatory drugs reduce swelling.
