Let's learn about cervical spinal cord compression (Cervical Myelopathy)

Do you sometimes wake up in the morning with a stiff neck and pain that makes it difficult to turn your head? Or do you feel like your arms are tingling or weak? Sometimes these things may last for a day or two and then go away. But if these symptoms persist, it could be a sign of a condition called Cervical Myelopathy. Don't worry, let's talk about this simply.

What is Cervical Myelopathy?

Simply put, Cervical Myelopathy is when the spinal cord in your neck is compressed. Just as a water pipe becomes compressed and the water stops flowing, when our spinal cord is compressed, the nerve messages passing through it are interrupted. This compression can occur for a variety of reasons. It could be due to an injury to the neck, a tumor, or a herniated disk.

There is a more common type of this, called Cervical Spondylotic Myelopathy . This often happens as we age. Just like the rest of our bodies, the bones, discs, and ligaments in the neck gradually weaken and lose their flexibility. These changes are what cause this condition. It's like the walls of an old house getting a little weaker.

How common is this condition?

In fact, this is what is called Cervical Spondylotic Myelopathy. If you look at the statistics of some countries in the world, thousands of people are hospitalized with these symptoms every year. This condition is not absent in Sri Lanka either. This is especially common among people who are over 40-50 years of age.

What are the symptoms of this?

Okay, now let's look at what symptoms you might experience with cervical myelopathy. These may vary slightly from person to person, but there are some common symptoms:

• Neck pain or stiffness: This is the first thing most people feel. It's not like they've just sprained their neck, but rather a constant, sometimes increasing, pain.
• Numbness or tingling in the hands and fingers: It may feel like a tingling sensation, or like ants are crawling around. This can happen in just one hand or in both hands.
• Weakness in the muscles of the hands and arms: You may find it difficult to do things that were previously easy. For example, you may feel weak in your arms when opening a water bottle or lifting a heavy object.
• Loss of balance while walking, difficulty walking: It may feel as if you are not stepping on the ground properly, or you may feel like you are slipping and falling. For some, their walking pattern may also change.
• Difficulty with fine motor skills: This means difficulty with small, delicate tasks, such as buttoning a shirt, writing with a pen, using cutlery, or putting a key in a door. Objects may also seem to just fall to the floor.

Why does this also affect the legs?

Now you may be thinking, 'If there's a problem in the neck, why does it affect the legs too?' It's like this. Our spinal cord is like a main road in the nervous system that runs throughout our body. It's along this road that messages from the brain travel to the arms, legs, and everywhere else in the body. So, when this main road gets jammed in the neck, it can also disrupt the messages going down to the legs. It's like a telephone wire breaking in one place, and the entire line stops working.

What causes this?

Okay, let's now look at what causes cervical spinal cord compression. Here are some things that can affect this:

• Bone Spurs: As we age, small bone spurs (like spines) can develop on our vertebrae. These can compress the spinal cord.
• Herniated Disk: The disc between our vertebrae is a jelly-like cushion. It can sometimes bulge out and press on the spinal cord.
• Congenital narrowing of the spinal canal in the neck (Narrow Cervical Canal): Some people may be born with this canal slightly narrow. In that case, even a slight change can easily cause compression.
• Rheumatoid Arthritis: This is also an inflammatory condition that affects the joints. It can also affect the joints in the neck and compress the spinal cord.
• Spondylolisthesis: This is when one vertebra slips forward over another. This can also compress the spinal cord.
• Spinal Degeneration: This is the main cause of the previously mentioned Cervical Spondylotic Myelopathy. Changes in the spine occur with age.
• Spinal Stenosis: Narrowing of the spinal canal due to various reasons.
• Traumatic Injury: This condition can also occur due to a severe injury to the neck, such as a car accident or a fall.
• Tumor: A tumor that forms on or near the spinal cord can compress the spinal cord.

Cervical Spondylotic Myelopathy, in particular, is caused by natural changes in the spine in our neck as we age. Just as the doors and windows of our house deteriorate over time, the function and structure of the parts of our spine also change. This narrows the path for the spinal cord, putting pressure on it. This is a natural part of aging.

Who is more likely to develop this?

This condition, called Cervical Myelopathy, can occur at any age, but some studies have shown that it is more common in people over the age of 30, especially those of Asian descent.

Cervical Spondylotic Myelopathy can affect anyone, but it is more common in men and people over the age of 40. The average age of diagnosis is around 64 years.

What happens if left untreated?

If this condition is not treated properly, the symptoms can gradually worsen. If this happens, complications such as:

• Very severe pain.
• Bowel and Bladder Dysfunction: This means difficulty defecating, urinating, and losing control.
• Nerve Damage: This can be permanent.
• Difficulty walking: Loss of balance, frequent falls, and becoming too weak to walk.
• Limited use of fingers, hands, and arms: You may become unable to perform tasks with your hands.
• Paralysis: In severe cases, parts of the body may become paralyzed.

Therefore, if you have symptoms like these, it is very important not to ignore them and seek medical advice immediately.

How do you find this?

Okay, now if you have these symptoms, how does a doctor diagnose cervical myelopathy?

First, the doctor will ask you about your symptoms and take a medical history. Then, they will do a physical exam and a neurological exam. During this time, they may test your balance, reflexes, and fine motor skills. If possible, they may also observe how you walk to see how your symptoms are affecting you.

In addition, you may also have some special imaging tests to look at the inside of your spine. These include:

• X-ray: This can be used to check for any changes in the bones, such as bone spurs.
• MRI Scan: This allows you to clearly see the condition of the soft tissues like the spinal cord, discs, and nerve roots. You can find out exactly where there is a compression and its extent.
• CT scan: This can also provide a detailed image of the structure of the bones.
• Myelogram: This involves injecting a special substance into the spinal canal and taking an X-ray or CT scan. This allows the spinal cord to be clearly seen where it is compressed.

Can it be cured completely?

A question that many people ask is, can it be completely cured? To be honest, there is no complete cure for all the causes of cervical myelopathy. However, surgery can greatly reduce symptoms, stop the condition from getting worse, and prevent complications. However, even after treatment, due to changes with age, other parts of the spine can be affected in the future. This means that even if one part is corrected, there is a chance that another part will develop a problem, especially as you get older.

What are the treatments?

Okay, now let's see what treatments are available for this. There are two main treatments:

1. Nonsurgical Management

2. Surgical Treatment

A doctor will usually first try non-surgical methods to control symptoms. However, this may vary depending on the severity of your symptoms and what is causing them.

Nonsurgical Management

For people with mild cervical myelopathy, doctors may recommend the following:

• Wearing a Neck Brace: This provides relief to the neck and also controls unnecessary neck movement.
• Physical Therapy: This is very important. A physical therapist will teach you exercises to strengthen your neck muscles, increase flexibility, and correct posture.
• Taking Medications:
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): For example, ibuprofen and naproxen. These reduce pain and swelling.
• Corticosteroids: These are powerful anti-inflammatories. They may be given for a short period of time.
• Pain Relievers: You can give general pain relievers like paracetamol or stronger ones.

But remember, although these non-surgical treatments may provide immediate relief from symptoms, they do not provide long-term relief or widen the narrowed spinal canal.

Surgical Treatment

If the condition of Cervical Myelopathy is severe, it means:

• If there is severe pain,
• If the muscles are weak,
• If numbness in the limbs persists,
• If you have problems with walking and balance,
• If it's difficult to do delicate work,

Your doctor may recommend surgery to decompress the spinal cord.

The type of surgery your surgeon recommends may vary depending on your symptoms, general health, and age. Some of the options include:

• Diskectomy: This involves removing part or all of the disc that is causing the herniation.
• Disk Replacement: An artificial disk is inserted to replace the removed disk.
• Laminectomy: A part of the vertebra called the 'lamina' is removed to create more space for the spinal cord.
• Laminoplasty: Without removing the 'lamina', it is reshaped to make room for the spinal cord.
• Spinal Fusion: This is a procedure that stabilizes one or more vertebrae by fusing them together . This is often done in conjunction with a discectomy.

Before surgery, the surgeon will explain the risks involved to you so that you can make an informed decision.

After the surgery, you will need to rest for a while. You should avoid lifting heavy objects or doing strenuous activities until your doctor tells you to. Your doctor will give you specific instructions on how to take care of yourself and when to come back for a check-up.

What will happen in the future? (Outlook)

Your outlook for cervical myelopathy depends on the cause of the condition. Mild cases can be treated with non-surgical treatments, and surgery usually has a good outcome.

However, if left untreated, cervical myelopathy can worsen. In severe cases, it can lead to permanent, irreversible nerve damage. This can lead to complications such as severe pain and difficulty moving.

Therefore, if you have symptoms of cervical myelopathy, see a doctor immediately. They will help you find the best treatment options for you.

How long can you live with this condition? How quickly will it progress?

Some people ask how long you can live with this condition, and how quickly it progresses. Mild cases do not affect your lifespan, but the symptoms can affect your quality of life. In severe cases, complications such as permanent nerve damage or paralysis can occur. Therefore, each person's prognosis will vary depending on many factors, including their general health and age. Your doctor is the best person to talk to about your condition.

How quickly it gets worse also depends on the cause. For example, it can come on suddenly after an accident, or it can develop gradually as you get older. Your doctor will look at your symptoms and imaging tests to give you a ``Prediction'' about how quickly it will get worse and your risk of complications.

Can this be prevented?

It is not possible to prevent all causes of cervical myelopathy. It is especially difficult to prevent spinal cord compression caused by natural changes in the body as we age, such as cervical spondylotic myelopathy. However, you can reduce your risk of injury from accidents. It is important to follow safe practices and avoid high-risk, dangerous activities.

When should I see a doctor?

If you have symptoms of cervical myelopathy, such as the aforementioned neck pain, numbness, weakness, and difficulty walking, you should definitely see a doctor. They will then perform tests to see if there is any compression of your spinal cord.

If you already know you have cervical myelopathy, if your symptoms get worse, or if you experience side effects from treatment, tell your doctor.

What questions should you ask the doctor?

When you go to see the doctor, it's a good idea to ask these questions:

• Where on my neck is this throbbing happening?
• What kind of treatment do you recommend?
• What are the side effects of the treatment?
• Do I really need surgery?
• How long does it take to recover after surgery?

The most important message to take home for you

Our spinal cord plays a very important role in the body. Unexpectedly, due to an accident or due to natural changes as we age, this spinal cord can be put under pressure. Just like a frequently used road or bridge, it becomes dilapidated over time. They also need maintenance and care to function properly. The same is true for our body. This care is very important, especially in this case of Cervical Myelopathy.

A doctor can help you manage your symptoms and relieve pressure on your spinal cord. This may require surgery. The thought of having neck surgery can be scary, but your medical team will do everything they can to protect you and prevent complications. So, if you have symptoms, don't ignore them and see a doctor right away. Early treatment can lead to better outcomes.

` Neck pain, Cervical Spondylotic Myelopathy, Spinal Cord Compression, Numbness in the hands, Spine, Neuropathy, Neck pain, Cervical Spondylotic Myelopathy, Spinal Cord Compression