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.

• Surgical Procedure

  A variety of surgical approaches and procedures are available, and the optimal choice of treatment remains controversial. [clinicaltrials.gov]

  These surgical procedures may include the following: cervical laminectomy cervical laminectomy and fusion cervical laminoplasty In some cases, the surgeon may perform surgery using both an anterior and a posterior approach. [columbianeurosurgery.org]

  Kaiser, M.D., F.A.C.S., Associate Director of The Spine Center at NewYork-Presbyterian/Columbia University Medical Center in New York City, discusses surgical procedures to treat cervical myelopathy, a condition where the spongy discs between the spine's [youtube.com]

• Lower Extremity Pain

  The number-one tipoff to my sensibilities is when a client presents with a history of same-sided somatic complaints of the neck, and upper- and lower-extremity pain or dysfunction, including sciatica. [massagetoday.com]

• Nausea

  BACKGROUND: Patients with subarachnoid hemorrhage (SAH) by hemorrhagic arteriovenous fistulas (AVFs) usually presents with meningeal signs, including headache and nausea, and focal neurologic deficit is found in rare cases. [ncbi.nlm.nih.gov]

  Intractable hiccup and nausea with periaqeductal lesions in neuromyelitis optica. Neurology 2005 ; 65 : 1479-82. 片山　晃、井上聖啓.　ウイルス性脊髄炎-臨床的特徴と最近の知見.　脊椎脊髄 1999 ; 12 : 537-45. Gruhn B, Meerbach A, Egerer R, et al. [hwm2.spaaqs.ne.jp]

  Severe optic neuritis and an episode of unexplained intractable nausea or hiccoughs are characteristic of NMO. 5 Coexisting peripheral neuropathy can occur in sarcoid, Sjögren syndrome, lupus, metabolic disorders (e.g., subacute combined degeneration) [neurology.org]

• Fecal Incontinence

  Six months ago as he woke up one morning, he had experienced loss of strength and sense of touch first in the right leg and after a few hours in the left leg, which was followed by urinary and fecal incontinence. [jpmrs.org]

• Hypertension

  Hepatic myelopathy (HM) is a devastating but rare complication of cirrhosis and portal hypertension that profoundly affects quality of life and improves only with liver transplantation. [ncbi.nlm.nih.gov]

  The patient has a 4-year history of NIDDM, hyperlipidemia, and hypertension. On examination, all cranial nerves were intact. [aclr.com.es]

  He had a history of hypertension and was a smoker. On examination, pedal pulses were present. He had a pale left optic disc and a left relative afferent pupillary defect. [pn.bmj.com]

  Medical resuscitative measures that address deterioration include: increased oxygenation, decreased inhalation or intravenous anesthetic, warming of irrigating solutions, induction of hypertension, and the addition of peroxide. [nature.com]

• Back Pain

  Patient can present with low back pain with weakness in the legs. [aclr.com.es]

  Common initial symptoms were back pain and low extremity weakness. Surgery was performed on 9 patients, biopsy on 2 patients, and radiation therapy on 1 patient. [ncbi.nlm.nih.gov]

  Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. [neckandback.com]

• Osteoporosis

  The most common causes of spinal stenosis are degenerative arthritis of the spine, disc degeneration, disc herniation, bone spur formation and kyphosis, the bending of the neck forward caused by osteoporosis. [bonati.com]

  Also bracing might be necessary in patients with extensive surgical procedures or poor quality bone, such as in osteoporosis. [pbcommercial.com]

  They can be brought about through Traumatic, degenerative or other causes. deformities Scoliosis Gibbus Wedged vertebrae Spinal traumas Vertebral fracture Vertrebal distorsion (whiplash) Degenerative spinal disorders Osteoporosis Prolapsed disc Malignancy [flexikon.doccheck.com]

  These comorbidities included osteoarthrosis (ICD-9 code 715.x), osteoporosis (733.0x), rheumatoid arthritis (714.x), diabetes mellitus (250.x), and hypertension (401–5.x). [doi.org]

  Brown-Sequard Syndrome Carpal Tunnel Syndrome Central Cord Syndrome Cervical Disc Disease Cervical Myofascial Pain Cervical Sprain and Strain Chronic Pain Syndrome Diabetic Neuropathy Multiple Sclerosis Myofascial Pain Neoplastic Brachial Plexopathy Osteoporosis [physio-pedia.com]

• Urinary Incontinence

  In his history, the patient had numbness in his legs and urinary incontinence for about one year. [jpmrs.org]

  The beginning is sometimes tricky - dominated by symptoms such as muscle weakness, stiffness (one or both) of the lower limbs, urinary incontinence, and back pain. [lekarzkatowice.blogspot.com]

  Urinary frequency and urgency, occasional dysuria, and urinary incontinence developed in the few weeks before admission. Four months earlier, she had undergone an extensive evaluation. [jamanetwork.com]

• Myelopathy

  TMS can aid physicians to:[9] Determine whether myelopathy exists Identify the level of the spinal cord where myelopathy is located. [en.wikipedia.org]

  He had significant spinal cord involvement with findings suggestive of heroin-associated myelopathy. [ncbi.nlm.nih.gov]

• Hyperreflexia

  Clinical hyperreflexia was tested at the MCP joint, using a six-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300°/second). [ncbi.nlm.nih.gov]

  Clinical examination documented limb weakness (58%) and hyperreflexia (42%) as the most prominent features. [journals.plos.org]

  Symptoms and Signs Cord compression commonly causes gradual spastic paresis, paresthesias, or both in the hands and feet and may cause hyperreflexia. Neurologic deficits may be asymmetric, nonsegmental, and aggravated by cough or Valsalva maneuvers. [merckmanuals.com]

  Clinical features vary depending on the level of the lesion and include local pain, stiffness, and impaired sensation, hypotonia, and hyporeflexia at the level of the lesion, and spasticity and hyperreflexia below the level of the injury level. [amboss.com]

• Clonus

  […] see: exam of spinal cord - presentation: ( Bertalanffy, et al ) - 61% presented with radicular symptoms - 16% had pure myelopathic symptoms - 23% had a combination of myelopathic and radiculopathy - upper motor neuron findings such as hyper-reflexia, clonus [wheelessonline.com]

  Physical examination revealed significant increase in deep tendon reflexes in the lower extremities and clonus. Hoffman's sign was positive in the left upper extremity. [ncbi.nlm.nih.gov]

  […] or paresthesia in the upper extremities Sensory changes in the lower extremities Motor weakness in the extremities Gait difficulties ("spastic gait," hesitant and jerky) Myelopathic or "upper motor neuron" findings such as spasticity, hyperreflexia, clonus [emoryhealthcare.org]

  Clonus showed low levels of reporting at secondary and surgical assessments, 21% and 26% respectively, although again lowest in the community setting at only 4%. [journals.plos.org]

• Irritability

  Cervical radiculopathy, often called a "pinched nerve," occurs when a nerve in your neck is compressed or irritated where it branches away from your spinal cord. [nm.org]

  These are usually divided between problems that come from mechanical problems in the neck and problems which come from nerves being irritated or pinched. [umm.edu]

  Causes include a nerve that is pinched, irritated, inflamed or damaged by disease. It can also be caused by a nerve that isn’t working properly because of low blood flow. [ohsu.edu]

• Long Tract Signs

  Physical examination commonly elicits long tract signs such as spasticity, hyperreflexia, and abnormal reflexes such as Babinski or Hoffman's sign. [uclahealth.org]

  […] extremities; - Brown-Séquard syndrome : - ipsilateral motor deficits with contralateral sensory deficits - may be the least advanced form of the disease; - Brachialgia and cord syndrome: radicular pain in the upper extremity along with motor and/or sensory long-tract [wheelessonline.com]

  This case highlights the need to look for long tract signs of physical exam to explore possible causes of cervical myelopathy to account for weakness in the legs, which cannot be accounted by the low back alone. [aclr.com.es]

  When the stenosis and myelopathy is severe, most patients will develop long tract signs (UMN) consisting of a wide-based gait, balance difficulties, and weakness. [uscspine.com]

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 [7]. 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 [8]. 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 [9].

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 [10].

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 [6].

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 [3].

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 [4].

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 [5].

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 [1]. 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 [2].

• Definition: Myelopathy refers to diseases governing the spinal cord. There are several types of myelopathy, which have been named based on their causative factors. These include radiation myelopathy which occurs as a complication of radiation therapy, compressive myelopathy which develops due to pressure exerted from a mass or hematoma or carcinomatous myelopathy occurs due to development of cancerous tumor in the spinal column.
• Cause: Various factors give rise to myelopathy. These include aging, various disease conditions such as arthritis, multiple sclerosis, inflammatory diseases, infections and tumor. Accidents and trauma are other potential factors that can give rise to myelopathy.
• Symptoms: In the initial stages, symptoms are mild and often go unnoticed. Affected individuals complain of pain in one or both the arms which is often accompanied by stiffness. There is also significant pain in the fingers and wrist. Individuals also complain of loss of balance and may even suffer from incontinence.
• Diagnosis: Preliminary physical examination is done followed by laboratory tests to assess complete blood count and sedimentation rate. This is done to analyze infections and inflammations as the causative factors. In addition, imaging studies such as CT scan and MRI are also indicated.
• Treatment: Treatment is cause dependent and is majorly geared towards correcting the underlying condition in order to relieve the nerve compression. Conservative treatment approach is adopted initially followed by steroid injections and surgery if other methods fail.

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