Cervical myelopathy, or more accurately called “cervical spondylotic myelopathy” (CSM), is the most common spinal cord disorder in those over age 55. The natural degenerative processes that happen as we age, in combination with normal wear and tear, can cause a narrowing of the space through which the spinal cord passes, compressing the nerves. This can cause pain and disability.
Cervical disc degeneration, common in those over age 40, creates a narrowing of the space between the vertebrae when the disc either shrinks or bulges. Unfortunately, this degeneration also has a tendency to accelerate if not properly addressed. This is because more pressure is put on the spinal joints as the disc degenerates, which in turn tends to cause further degeneration. Inflammatory diseases such as rheumatoid arthritis also can cause degeneration in the joints of the neck, causing pain and stiffness. Injury or trauma to the cervical spine—typically related to auto accidents or rough contact sports—can also cause CSM. In rare cases, tumors and congenital abnormalities of the spine may trigger or contribute to this condition.
Symptoms of cervical myelopathy include pain and stiffness in the neck, tingling or numbness (particularly in the arms and legs), weakness (such as having trouble lifting things or frequently dropping objects), difficulty walking, and problems with coordination. For example, patients suffering from CSM may have trouble buttoning their clothing or feeding themselves.
A diagnosis of CSM can be confirmed by x-ray, MRI and/or use of a special kind of CT scan, called a myelogram, which can show the spinal canal in greater detail, including any bone spurs, and the size of the opening through which the spinal cord passes.
If CSM is not treated, it will cause a steady degeneration about 40% of the time. Approximately 20% of cases resolve spontaneously, and the remaining 40% stabilize. There is currently no way to determine which outcome will result.
Conservative treatment of CSM includes the following:
- Anti-inflammatory drugs such as ibuprofen to reduce swelling and pain
- Soft collars to support the neck and reduce movement so that the soft tissues supporting the neck are allowed to rest (though this should only be used in the short term, as long-term use can cause a weakening of the neck muscles)
- Exercise to strengthen the muscles supporting the neck
- Steroid injections to decrease pain and swelling (although these only result in temporary relief)
More severe cases of spinal myelopathy can require surgical treatment, which may include laminectomy (removing part of the vertebra), discectomy (removing part of the intervertebral disc) or spinal fusion. If you have CSM, your chiropractor can help you understand your condition, the range of options available and the course of treatment that may be best for you.