Cervical myelopathy is a condition that happens when the spinal cord in the neck is compressed or squeezed. There are many things that can cause this, but one of the most common is cervical spondylotic myelopathy, which happens when the spine changes with age. This condition is more common in individuals over 50. The changes in the spine can cause disc herniations or growth in the ligaments in the back of the spine. Other causes include hardening of the posterior longitudinal ligament or the ligamentum flavum, which are soft tissue bands that normally help support the cervical spine. Sometimes people are born with a narrow spinal canal, which can also make them more likely to develop cervical myelopathy.
Symptoms of myelopathy can include a loss of fine motor skills, coordination problems and pain or stiffness in the neck. Patients may also experience numbness, tingling and weakness in the shoulders, arms and hands. Symptoms typically start slowly and worsen gradually over time, leading to a decrease in functional ability. Older patients and those who have had symptoms for more than 18 months generally have a worse prognosis.
Non-surgical treatments for myelopathy include anti-inflammatory medications, physical therapy and corticosteroid injections. However, these treatments only provide temporary relief, and if symptoms continue to worsen, surgery may be necessary. The goal of surgery is to relieve pressure on the spinal cord by decompressing the spinal canal.
There are two main approaches to surgery: the posterior approach, in which a portion of the posterior aspect of the spinal canal is removed in a procedure known as laminectomy, and the anterior approach, in which the intervertebral disc is removed and the remaining vertebral bones are fused to create more space in the spinal canal. This procedure is known as an anterior cervical discectomy and fusion (ACDF). Your surgeon can recommend a specific surgery based on your situation and symptoms.