By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)
Walking becomes wobbly. Body movement feels slow. The hands do not seem to follow instructions. These are not normal signs of ageing. These may be signs of spinal cord compression or cervical myelopathy.
What is cervical myelopathy?
Cervical myelopathy is a spinal cord problem that is caused by nerve compression in the neck. It can occur in the back as well. But it is more common in the neck. What is the spinal cord? There are 2 types of nerves in the spine. The main nerve is called the spinal cord. It connects directly with the brain. The second type is the branches of the spinal cord – nerve roots. It connects the spinal cord with other parts of the body.
We need to understand the functions of the spinal cord before we understand the symptoms. The spinal cord transmits nerve signals to and from the brain. We can move our bodies and feel something with our hands and feet because the spinal cord is working properly.
When the spinal cord is compressed, the nerve signals to and from the brain can’t be transmitted properly. There is a delay in neurotransmission. We can’t feel with our feet properly. No sensory feedback. The walking becomes wobbly. This problem also happens with the hands. So, hand coordination becomes affected. Buttoning the shirts or using chopsticks may be difficult. Handwriting becomes ugly. The patients feel clumsy.
These are the symptoms of cervical myelopathy. With time, the hands and legs become weak. And in severe cases, it may lead to paralysis.
Is neck pain a sign of cervical myelopathy?
Many people experience neck pain. It is a non-specific symptom. Only a small proportion of people with neck pain suffer from cervical myelopathy. In fact, some people with cervical myelopathy do not have any neck pain at all.
Cervical spondylotic myelopathy is the most common type of cervical myelopathy. Spondylotic means wear and tear. So, neck pain is more likely caused by spondylosis or wear rather than myelopathy.
As we grow older, the spinal canals become smaller due to wear and tear. Bulging or herniated discs, bone spurs and thick ligaments in the neck are parts of spinal degeneration. The changes can pinch the spinal cord and cause myelopathy.
How is treated?
We usually suspect cervical myelopathy from a physical examination. MRI scan is used to confirm the diagnosis and to detect any damage in the spinal cord. If the spinal cord is compressed, surgery is necessary to free up the spinal cord and to prevent worsening of the symptoms.
There are a many different ways to treat it. You can discuss with your doctor to determine the best way to free up the spinal cord.
Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.