Cervical Spondylitic Myelopathy - Spinal Cord Compression
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Seven vertebrae make up the cervical area of your spine. The back part of the vertebra arches to form the lamina. The lamina creates a roof-like cover over the back of the opening in each vertebra. The opening in the center of each vertebra forms the spinal canal.
Intervertebral discs are located between the vertebrae in the cervical spine. The discs are made up of strong connective tissue. Their tough outer layer is called the annulus fibrosus. Their gel-like center is called the nucleus pulposus. The discs and two small joints connect one vertebra to the next. The discs and joints allow movement and provide stability. The discs also act as a shock-absorbing cushion to protect the cervical vertebrae.
The top section of the cervical spinal canal is very spacious. It allows more room for the spinal cord than any other part of the vertebral column. The extra space helps to prevent pressure on the spinal cord when you move your neck.
As cervical spondylitic myelopathy progresses, the legs become weaker and stiffer. It may be difficult to straighten your legs. You may have difficulty controlling your bowel and bladder. People with advanced cervical myelopathy may need an ambulation device, such as a cane or walker, to aid walking.
Your doctor may order X-rays to see the condition of the vertebrae in your cervical spine.
Your doctor may order computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to get a better view of your spinal structures. CT scans provide a view in layers, like the slices that make up a loaf of bread. The CT scan shows the shape and size of your spinal canal and the structures in and around it. The MRI scan is very sensitive. It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors. X-rays, myelograms, CT scans, and MRI scans are painless procedures.
In some cases, doctors use nerve conduction studies to measure how well the cervical spinal nerves work and to help specify the site of compression. Doctors commonly use a test called a nerve conduction velocity (NCV) test. During the study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured.
Somatosensory evoked potentials (SSEPs) or motor evoked potentials (MEPs) are used to test how the spinal cord transmits nerve signals about sensory or movement information. Your doctor will place sticky patch-like electrodes on your skin that covers a spinal nerve. The NCV test may feel uncomfortable while it is performed.
An electromyography (EMG) test is often done at the same time as the NCV test. An EMG measures the impulses in the muscles to identify damage or decay. Muscles need impulses to perform movements. Your doctor will place fine needles through your skin and into the muscles that the spinal nerve controls. Your doctor will be able to determine the presence of muscle damage, as well as the quality of the nerve impulses conducted when you contract your muscles. The EMG may be uncomfortable, and your muscles may remain a bit sore following the test.
Surgery is used to relieve spinal cord compression. The majority of conditions that cause spinal cord compression are located in front of the spinal cord. For this reason, anterior cervical decompression and fusion (ACDF) surgery is commonly used to treat cervical spondylitic myelopathy. The goals of ACDF surgery are to remove pressure from the spinal cord, relieve pain, restore function, and stabilize the spine.
Next, the surgeon replaces the disc or discs with a bone graft or interbody fusion cage to support the cervical spine. Surgical hardware including plates and screws may be used. The surgical hardware secures the vertebrae together and allows the bone grafts to heal.
At the completion of your ACDF surgery, your surgeon will close your incision with stitches. You will receive pain medication immediately following your surgery. You will wear a neck brace or collar while your fusion heals.
You should expect to stay overnight in the hospital. You may need some help from another person during the first few days or weeks at home.
Following surgery, your doctor will initially restrict your activity and body positioning. You should avoid lifting, housework, and yard-work until your doctor gives you the okay to do so. You will wear a neck brace for support. Once your neck has healed, physical therapists will teach you flexibility and strengthening exercises. You will also learn body mechanics and proper postures.
The recovery process is different for everyone. It depends on the particulars of your surgery and the extent of your condition. Your surgeon will let you know what to expect.
Am I at Risk
There are several factors which may contribute to cervical spondylitic myelopathy including:
_____ Increasing age is associated with an increased risk for cervical spondylitic myelopathy. It most frequently occurs in people over the age of 50, but may occur at any age.
_____ Osteophytes or bone spurs increase the risk of cervical spondylitic myelopathy.
_____ Arthritis in the neck can cause the facet joints to enlarge, which increases the risk of cervical spondylitic myelopathy.
_____ Thickened ligaments in the spinal canal, particularly the ligamentum flavum, can narrow the spinal canal and may lead to cervical spondylitic myelopathy.
_____ Dislocated or subluxed vertebrae, bones that have moved out of position, increase the risk of cervical spondylitic myelopathy.
_____ People that are born with a small spinal canal have an increased risk of cervical spondylitic myelopathy.
_____ “Wear and tear” or trauma increases the risk of cervical spondylitic myelopathy.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.