Cervical stenosis with myelopathy
Cervical stenosis pinches the spinal cord
As we age, the spine may develop degenerative changes
in the joints that can create tightening of the spinal
canal. Over time this process may lead to pinching the
spinal cord and compromise of coordination of the extremities.
Symptoms of cervical stenosis with myelopathy
People with this condition may note one or more of
the following symptoms:
-
Heavy feeling in the legs
-
Inability to walk at a brisk pace
-
Deterioration in fine motor skills (such as handwriting
or buttoning a shirt)
-
Intermittent shooting pains into the arms and
legs (like an electrical shock), especially when
bending
their head forward (known as Lermitte’s phenomenon)
-
Arm pain (radiculopathy)
Often it is the arm pain that prompts someone with
this condition to seek medical treatment, and then the
myelopathy is discovered through medical history and
physical exam.
Cervical stenosis with myelopathy affects the nerves
Myelopathy affects the nerve tracts that run inside
the spinal cord (long tracts) and deficits in these
long tracts can be picked up on physical exam. For example:
-
Muscular tone in the legs will be increased,
-
Deep tendon reflexes in the knee and ankle will
be accentuated (hyperreflexia)
-
Forced extension of the ankle may cause the foot
to beat up and down rapidly (clonus)
-
Scratching the sole of the foot may cause the big
toe to go up (Babinski reflex) instead of down (normal
reflex)
-
Flicking the middle finger may cause the thumb
and index finger to flex (Hoffman’s reflex)
-
Compromised coordination may be evidenced by difficulty
walking placing one foot in front of the other (tandem
walking)
Diagnostic tests for cervical stenosis with myelopathy
An MRI scan and/or a CT with myelogram can show
the tight canal and associated spinal cord pinching.
The condition may be present at one or several levels
in the spine.
Often, cervical stenosis with myelopathy is associated
with some degree of instability, and flexion/extension
lateral cervical spine x-rays are useful to rule out
abnormal motion and instability.
Somatosensory Evoked Potentials (SSEP), an electrical
study, is done by stimulating the arms/legs and then
reading the signal in the brain. A delay in the length
of time that it takes to get to the brain indicates
that there is a compromise of the spinal cord.
Treatment for cervical stenosis with myelopathy
The only effective treatment for myelopathy is surgical
decompression of the spinal canal. If the patient also
has a radiculopathy (myeloradiculopathy), conservative
treatment may help relieve the arm pain.
Myelopathy is a generally progressive condition that
develops slowly. Symptoms may not progress for years,
and then difficulties with coordination may suddenly
increase. Unfortunately, the symptoms rarely improve
without spine surgery to decompress the affected area.
Surgical decompression may or may not improve the symptoms.
Typically, the main goal of the spine surgery is to arrest the
progressive nature of the condition and stabilize the
patient’s neurological condition.
Surgical decompression can be performed through an
anterior (front) approach or posterior (back) approach.
The type of approach is generally dependent on the surgeon’s
preference and where the majority of the compression
is located (in the front or back).
Often, multiple levels need to be decompressed, so
the spine surgery tends to be more involved than that for
disc herniations or foraminal stenosis.
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