Myelopathy is an umbrella term for various problems affecting the spinal region.
Myelopathy may present with neck stiffness along with severe pain in the either one or both sides of the neck. The pain and associated stiffness may radiate to the arms and shoulders. Individuals suffering from myelopathy, experience lack of control and significant loss of coordination while carrying out certain activities. In the initial stages, individuals may face problem while walking or with maintaining balance. There may be associated muscle weakness and individuals also report a certain degree of disability. Other symptoms include development of stabbing pain in the elbow, arm, fingers and wrist and hyperreflexia. Certain percentage of individuals also experience incontinence and sexual dysfunction.
The signs and symptoms of the condition are carefully observed and taken note of. This is followed by physical neurologic examination that would involve testing reflexes, including abdominal reflexes, along with sensory testing of the body. This will be followed by laboratory tests to analyze levels of vitamin B12 or heavy metals present in the blood. Levels of white blood cells and erythrocyte sedimentation rate would also be tested, to examine infection or inflammation as the source of myelopathy.
Lumbar puncture test would also be done in order to rule out multiple sclerosis or meningitis. Imaging studies such as CT scan, radionuclide bone scan and MRI of spinal cord will also be required . In conditions, when the diagnostic procedures results are inconclusive, then bone biopsies or cultures are indicated.
Treatment is geared towards treating the underlying disease condition and effective management of symptoms. In case of fracture or dislocation of vertebrae, the patient is put on traction, followed by immobilization for several weeks . Rehabilitation therapy would also be required and medications to relieve pain and stiffness would also be employed.
Steroid medications to relieve inflammation due to arthritis are also indicated. If the pain is severe, then steroid injections may be given. These are given in the epidural region and used only in cases when conservative treatment did not bring about the desired effect .
In instances, when medications and physical therapy do not yield positive results, then surgery would be opted for. Surgical procedures to relieve nerve compression would be carried out. In many cases, spinal fusion would also accompany the surgical procedure in order to reduce the risks of complications after surgery .
Prognosis depends on the causative factors. For example, in case of infection complete recovery is possible. When traction is imparted and there are no signs of residual damage to the spinal column, then too complete recovery is a possibility. Surgery may be required in certain cases to relieve the nerve under pressure. Failure to do so can lead to irreversible permanent damage in the long run. However, in many instances, other forms of treatment to manage the symptoms are required. Recovery following removal of herniated disc is favorable and prognosis is excellent if there is no residual damage to the spinal cord .
Aging process that causes normal wear and tear in the spinal region is one of the major causes of myelopathy. In addition to aging, accidents or other traumatic events are other significant factors that can cause nerve deficit in the spinal cord. Other causes include spinal stenosis, development of tumor in the spinal column, degenerative disorders governing the disc and disease conditions such as multiple sclerosis. In many instances, inflammatory diseases such as rheumatoid arthritis can also give rise to the condition of myelopathy. Congenital abnormalities and infections can also lead to the disorder, but such cases are rare.
The exact prevalence of myelopathy is unknown. However, the incidence rate of various causes that gives rise to the condition has been reported. Statistics have revealed, that in US, there are about 12,000 to 15,000 spinal cord injuries every year .
It was also estimated that, cervical myelopathy strikes approximately 50% of men and 33% women aged 60 years and above. This clearly explains that age is the major factor for development of myelopathy. Prevalence rate of tumors in the spinal region is reported to be 0.5 to 2.5 per 100, 000 individuals in US. In addition, it was also reported that, 5 to 10% individuals with cancer are also likely to develop tumor in the epidural region, which is known to cause about 25,000 cases of myelopathy.
Aging causes degenerative changes to take place in the spine, paving way for development of myelopathy. Degenerative changes may exert pressure on the cartilage preventing the joints in the spine from working properly. This in turn favors the degeneration to continue causing further damage to the spinal region. Myelopathy can also occur due to herniated discs which also favor nerve compression .
Myelopathy that occurs due to trauma or accident, significantly affects the muscles and ligaments that support and cushion the spine. Accidents can also lead to bone dislocation which in turn compresses the neighboring nerve giving rise to myelopathy .
It is not always possible to prevent the onset of myelopathy. Aging process cannot be controlled, but certain factors can be adopted to keep the spinal column and neighboring muscles strong. Steps to prevent accidents should also be taken. However, in unforeseen situations, individuals are advised to undergo complete treatment plan to avoid irreversible damage to the spinal cord.
Development of disorders in the spinal region that gradually inflict compression is the major reason for occurrence of myelopathy. Nerve compression by osteophytes or extruded disk in the cervical region is a common cause of myelopathy. It is known to be one of the major causes of neck and cervical pain. When nerves in the spine region get compressed due to accident or trauma, the condition is then referred to as spinal cord injury . When myelopathy occurs due to infections or inflammations, the condition is known as myelitis and when the disease is vascular in nature, it is known as vascular myelopathy .