Myelopathy

Myelopathy is an overall term for changes in sensation, motor performance, gait and balance, bowel or bladder function, or function caused by a disorder or disease of the spinal cord. Also referred to as spinal cord compression, up to 10% of people who have symptoms of spinal stenosis develop myelopathy.

What causes myelopathy?

Myelopathy is caused by injury, abnormality or disease in or around the spinal cord. The patient’s symptoms relate to the specific type and mechanism of spinal cord injury and the specific location and extent of spinal cord damage. Types of injury include compression; cutting, shearing, tearing, or stretching; and alterations in the cerebrospinal fluid (CSF) that nourishes the spinal cord.

Compression is the mechanism of injury in most cases of myelopathy and can occur in two ways: swelling of the spinal cord or other soft tissues within the bony spinal canal, or narrowing of the bony canal. Causes of soft tissue expansion include inflammation or infection; a mass, such as a tumor, hematoma, or cyst; or increased volume of CSF. Causes of spinal canal narrowing (spinal stenosis) include overgrowth of bone into the canal, arthritis or another bone disease, or disc displacement, herniation, or disease.

External trauma is the usual mechanism for a cutting, shearing, tearing, or stretching injury, although such injuries can occur during spinal surgery.

How is myelopathy diagnosed and treated?

Key diagnostic steps include a careful medical history, symptom and pain history, physical exam, and imaging studies. Magnetic resonance imaging (MRI) is key. Computed tomography (CT), plain x-rays, and specialized studies may also be ordered. For example, myelography (imaging after injection of a dye into the CSF) helps evaluate tumors, inflammation, or adhesions. 

Laboratory studies may include spinal/lumbar puncture to obtain CSF for evaluation of chemical, inflammatory, or infectious causes of spinal cord injury such as poor nutrition or oxygenation, vitamin/mineral deficiencies, electrolyte imbalance, and toxic chemicals (including some drugs). CSF analysis can also help to evaluate hemorrhagic stroke, leukemia, severe back pain, and headaches. Lumbar puncture and myelography may be used to inject drugs into the CSF to treat infection, inflammation, or leukemia. 

Traumatic injuries, masses, and severe or progressive compression symptoms usually require surgery. Cervical myelopathy is especially difficult to diagnose and treat because the neck contains major blood vessels, nerves, and other vital structures. If affected, their symptoms may complicate diagnosis and their presence complicates invasive management. Anterior and posterior surgical approaches to the cervical spine have different risks and potential benefits depending on patient factors. Some infections and milder compression symptoms may respond to appropriate medications (antibiotics, anti-inflammatories, analgesics). 

Nonmedical-surgical measures to increase function and decrease pain may include an individualized exercise plan, nutrition counseling, mobility aids, and acupuncture and other alternative therapies.

Pain associated with myelopathy may be due to problems in the vertebrae and facet joints of your spine, and/or in the muscles, ligaments, and nerves of your spine. Don’t spend another day with pain. Trust the doctors at Integrated Pain Management to best diagnose and treat your symptoms.