Myelopathy: what is it, causes, symptoms, treatment, prognosis

What is myelopathy?

Myelopathy Is the term used to describe any neurological deficit associated with the spinal cord. This is usually due to compression of the spinal cord by an osteophyte or extruded disc material. Most often, it is localized in the cervical spine, but it can also occur in the thoracic and lumbar spine.

There are many primary infectious, inflammatory, neurodegenerative, neoplastic, idiopathic, and nutritional disorders that lead to myelopathy. These causes are much less common than discogenic diseases, metastases, or trauma.

Nurik's classification (scale) can be used to determine the severity of myelopathy. The classification is based on the patient's gait abnormality. This analysis has demonstrated its sensitivity and validity.

The diagnosis of myelopathy depends on the neurologic location in the spinal cord rather than the brain or peripheral nervous system. In addition, the presence or absence of significant pain or trauma and the mode of its occurrence are the primary criteria for evaluating myelopathy by clinical category.

Clinically relevant anatomy

The vertebral column begins in the cervical region under the skull. It continues into the thoracic region and finally into the lower back, where it connects to the sacrum and pelvis. The cervical spine consists of 7 vertebrae, the thoracic spine of 12 vertebrae and the lumbar spine of 5 vertebrae.

The spinal canal runs between the body and the process of the vertebrae. This is the area in the middle of the spine where the spinal cord goes down and the nerves go to the limbs. The brain and spinal cord are packaged in 3 membranes: dura mater, arachnoid, and pia mater. Each has its own structure and function.

Although the spinal cord is well protected, it can be damaged by epidural or intradural causes. This is what happens when it comes to myelopathy.

Types of myelopathy

Myelopathy can occur in any area of ​​the spine and has a different name depending on where it appears in the spine.

- Cervical myelopathy.

Neck myelopathy occurs in the neck and is the most common form of the disease. Neck pain is one of the symptoms of cervical myelopathy, but not in all patients.

- Thoracic myelopathy.

Thoracic (chest) myelopathy occurs in the middle of the spine. The spinal cord in this area is usually compressed due to protrusion or herniation of intervertebral discs, bone spurs, or spinal injuries.

- Lumbar myelopathy.

Lumbar myelopathy is a rare condition because in most people the spinal cord ends in the upper lumbar spine. However, if the spinal cord is low or connected, it can be affected by myelopathy.

Causes and risk factors

There are many risk factors that can cause or develop myelopathy:

• herniated disc;
• spinal degeneration;
• degeneration and damage to the facet joints;
• hypertrophy of the yellow ligament;
• calcification of the yellow ligament;
• compression due to extradural mass (spinal tumor);
• post-traumatic deformities;
• infections;
• angular kyphosis (congenital, tuberculous, neurofibromatosis and post-traumatic kyphosis);
• vascular disorders (vascular malformations, spinal cord infarction and epidural hematoma);
• eating disorders.

Risk factors:

1. Age.
2. The degree of motor and sensory deficits.

Signs and symptoms

The following symptoms are possible:

• muscle weakness;
• changes in muscle tone;
• loss of sensation (trunk and legs) and spasticity;
• lack of coordination;
• trouble walking;
• backache;
• disorders of urination.

Symptoms of cervical myelopathy may initially be very subtle and therefore potentially overlooked. It is essentially a painless condition because pressure on the spinal cord causes loss of function rather than pain in the affected limbs. People with myelopathy often describe feelings of numbness and clumsiness in their hands. They lose their dexterity, especially when doing small tasks like writing. They may also have reduced grip strength and tend to drop objects. An altered hand sensation can range from mild numbness to a deeper feeling that the hands are completely numb, swollen, and functionally useless. The legs may suffer in a similar way. People may describe feelings of numbness and clumsiness in their legs, as if they have lost control of leg function.

Symptomatic disorders

Diagnosing myelopathy can be difficult because the clinical manifestations are diverse and sometimes similar to those of other diseases. This is why it is so important to have a detailed history and complete physical examination of the patient. In this case, it is very difficult to know what symptoms appear as a result of myelopathy or mediated disorders.

Other pathologies that may be associated with myelopathy:

• spinal stenosis;
• herniated disc;
• spondylolisthesis;
• bulge of the disc.

Diagnostics

The diagnosis of myelopathy depends on the neurologic location. Imaging myelopathy is critical.

The main method:

• Magnetic resonance imaging (MRI).

MRI can show a decrease in the diameter of the spinal cord or abnormalities in the spinal cord and hypertension in the central brain.

Other methods:

1. Computed tomography (CT). Computed tomography shows damage to bones or ligaments, if present.
2. Myelogram.
3. X-ray. X-rays can reveal osteophytic narrowing of the spinal canal or bone destruction.

Note that magnetic resonance imaging is considered the gold standard for diagnosing myelopathy. Physical examination usually results in signs of tract elongation such as spasticity, hyperreflexia, and abnormal reflexes. The Hoffmann, Babinsky, and clonus reflexes are frequently tested reflexes. Someone with myelopathy has a positive Hoffman and / or Babinski and / or clonus test. Progressive deterioration in hand and gait function is also common. Thus, it may be useful to investigate the patient's gait cycle using a toe-to-heel gait and a Romberg test.

Treatment

Treatment for myelopathy depends on the cause. However, in some cases, the cause may be irreversible, so treatment can only go as far as relieving symptoms or slowing the further progression of the disorder.

- Non-surgical treatment.

Nonsurgical treatments for myelopathy may include fixation, physical therapy, and medication. These treatments can be used for mild myelopathy and are aimed at relieving pain and returning to daily activities.

Conservative treatment does not relieve compression. Symptoms will progress - usually gradually, but sometimes acutely, in some cases. Some progression may be irreversible even with treatment, so it is important to stop any progression if it is detected at a mild stage.

- Surgery.

Spinal decompression surgery is a common treatment for myelopathy that relieves pressure on the spinal cord. Surgery can also be used to remove bone spurs or herniated discs if they are found to be the cause of myelopathy.

For advanced myelopathy caused by stenosis, your doctor may recommend a surgical procedure to enlarge the canal space of the spinal cord (laminoplasty). It is a motion-preserving procedure, which means that the spinal cord remains flexible at the compression site. For various reasons, some patients may not be candidates for laminoplasty. An alternative is decompression and fusion, which can be done anteriorly or posteriorly. During fusion, the vertebrae are fused to eliminate movement in the affected segment of the spine.

Minimally invasive spine surgery can offer relief with less risk of complications and potentially faster recovery than traditional open surgery procedures.

While the patient is waiting for surgery, a combination of exercise, lifestyle changes, hot and cold therapy, injection, or oral medication can help control any pain symptoms. It is very important to take any medication exactly as prescribed by your doctor, as many pain relievers and muscle relaxants can cause side effects, especially with long-term use.

Forecast

The prognosis of the disease depends on its causes and the presence of persistent damage to the nerve structures. Traction and immobilization can lead to complete recovery if there is no spinal cord injury. A complete cure is possible with infections. For chronic diseases such as arthritis or osteoporosis, the effect of therapy may be temporary, or if the disease progresses, then a permanent loss of performance up to a wheelchair is possible.

Spinal cord injury or compression can lead to irreversible changes in the spinal cord, including loss of sensation in various parts of the body, as well as loss of voluntary movement in the limbs. Rehabilitation after removal of the tumor depends on the residual damage and, if it is a carcinoma, then on the formation of secondary foci of tumor growth. Rehabilitation after removal of a herniated disc (discectomy) gives a good prognosis, but only if the spinal cord has not undergone irreversible changes as a result of compression.

Complications

Complications of myelopathy include:

• addiction from anti-inflammatory drugs;
• constant violation of sensitivity;
• violation of voluntary movements;
• spinal deformities;
• dysfunction of the bladder and intestines.