Spinal Conditions: Myelopathy
Definition
Myelopathy is a condition caused by spinal cord compression and may present with any of the following: numbness or weakness in the arms or legs, poor balance, difficulty using the hands, brisk reflexes, and bowel or bladder incontinence.
Causes
Myelopathy results from spinal cord compression usually due to a disc herniation or bone spurs. An ossified posterior longitudinal ligament or a tumor may also compress the spinal cord. Cord compression usually occurs in the cervical spine but may occasionally occur in the thoracic spine.
Treatment Options
Myelopathy should be treated surgically if the patient is of reasonable enough health to tolerate an operation. Non-operative treatments such as therapy, medicines, and injections do not relieve the spinal cord compression.
Prognosis
Without surgical intervention all myelopathies worsen. It is usually in a slow, step-wise fashion but some causes of myelopathy such as acute disc herniations can produce severe, sudden deterioration in function. Prognosis for recovery after surgery depends on the cause of the myelopathy as well as the stage of the myelopathy (walking independently, walking with an aid, or wheelchair bound). 70% of patients see improvement in symptoms (sometimes complete), 15% of patients see no further deterioration but no improvement, and 15% of patients continue to decline despite surgery. Those patients who continue to decline usually present with more severe symptoms prior to surgery. 100% of patients decline without surgery.
Surgical options
The approach to relieve spinal cord compression can be either from the front, or anterior, approach or from the back, the posterior approach. Both approaches can be successful; choice of approach typically depends upon which direction the spinal cord is being compressed. Usually, an anterior approach is chosen for anterior compression of the cord and a posterior approach for posterior compression.
