Guest post: What is Cervical Myelopathy?
Cervical Myelopathy
Cervical myelopathy is a condition in which the spinal cord is compressed in the cervical spine. Most commonly this is a degenerative process that occurs as we age due to disc bulging, bone spurs, and instability between adjacent vertebrae. When the spinal cord has unwanted pressure that causes deformity of the underlying nerve tissue or obstructs the blood flow into the nerves, a clinical syndrome of symptoms may present themselves. Most commonly these symptoms include clumsiness in the hands with a difficulty in performing fine motor skills such as buttoning buttons and fumbling with daily activities like counting change or using keys. Additionally, noticing changes in handwriting, feeling off balance, and diffuse numbness and tingling throughout the entire upper extremities are common symptoms.
Cervical myelopathy is a progressive disease that is characterized by a stepwise deterioration with times of worsening symptoms followed by stability of the symptoms until the next decline. If left untreated, the condition can progress to severe functional limitations and possibly paralysis.
Diagnosis of cervical myelopathy is done by clinically evaluating the patient's reflexes, gait, muscle strength, and other special tests to evaluate for upper motor neuron signs. If a physician suspects cervical myelopathy after a clinical evaluation, a detailed evaluation of the spinal cord is performed typically with an MRI to see the degree of compression of the spinal cord as well as to evaluate for any permanent nerve damage that may have already occurred.
Treatment of cervical myelopathy is based upon the patient's symptoms. In mild symptoms, conservative management with medications and close follow-up to monitor for progression of symptoms can be performed. In situations where impairment and progressive symptoms are present, surgical intervention is often discussed. Surgical treatment depends on multiple factors including the number of vertebral segments involved, the overall alignment of the spine (lordosis, neutral, or kyphosis), and the degree of degeneration of the disc and facet joints. Ultimately, surgical intervention is performed primarily to prevent any progression of symptoms and to stop the stepwise deterioration from continuing. Unfortunately even with surgical interventions, permanent nerve damage may have already occurred, which is why it is imperative that early evaluation be performed when symptoms begin. Fortunately, patients will usually see improvement of their preoperative symptoms when the nerves have been decompressed.
Contributed by Dr. James Klunk – Orthopaedic Spine Surgeon at OSS Health.
Dr. James Klunk is an orthoapedic spine surgeon with special expertise in adult spinal degeneration and deformity. In his practice, non-operative management should be explored to its fullest extent, but once a patient’s quality of life is jeopardized, he utilizes the latest and most advanced technologies in robotics and navigation, motion preservation, and minimally invasive techniques to return his patients to a healthy, active lifestyle.
Dr. Klunk was born and raised in York county, and after graduating Spring Grove High School, he completed his undergraduate studies at Gettysburg College, graduating Magna Cum Laude. He received his medical degree from Philadelphia College of Osteopathic Medicine in Philadelphia, PA, and completed residency training at WellSpan York Hospital in York, PA. He also completed a post-residency spine surgery fellowship at MedStar Union Memorial Hospital in Baltimore, MD.
Dr. Klunk sees patients in the OSS Health Orthopaedic Office at 470 Eishenhower Drive in Hanover.