What Is Myelopathy?
Myelopathy is a condition in which the spinal cord becomes severely compressed, enough to disrupt its task of transmitting nerve signals to and from the brain and body. This condition is sometimes described as “a loss of spinal cord activity.”
A helpful analogy would be to compare the spinal cord to a garden hose. When the hose lies straight, water flows through it at its maximum rate and speed. However, if the hose gets a bend or kink, the flow of water slows. If the hose gets flattened—say, beneath the tire of a car or under a careless neighbor’s foot—the water can be blocked completely and stop flowing altogether.
The same sort of pinching can happen to the spinal cord. Although it is protected from bends, kinks, and car tires by the vertebrae of the spinal column, the spinal cord runs through a very small channel of bone, with virtually no clearance around it. Should anything impinge upon that tiny space surrounding the spinal cord, in any location within the spine, myelopathy may occur.
Myelopathy is not an injury to the spinal cord itself. However, if left untreated, it may lead to irreparable damage to the cord.
What Causes Myelopathy?
Myelopathy normally does not affect most people under the age of 50. Typically, myelopathy appears in older adults, manifesting as a slowly developing, degenerative condition caused in part by normal aging. (This age-related process is known as spondylosis.)
Among the issues that may develop with spondylosis, and thereby contribute to myelopathy, are the following:
- loss of water within discs, which causes a loss of resilience and flexibility
- degeneration of cartilage between vertebrae (a form of arthritis)
- degeneration of facet joints within vertebrae
- development of spinal stenosis, the narrowing of the spinal column and the holes in the vertebrae, through which the spinal cord and its connected nerve roots pass
Spondylosis and Myelopathy
The symptoms and discomfort that result from spondylosis and may develop into myelopathy most commonly manifest in the following four ways:
- Bone spurs: growth of unwanted bone into the spinal column
- Herniated discs: the leakage of the gel-like center of a disc into the surrounding outer ring of disc tissue. Also known variously as a slipped disc, ruptured disc, torn disc, etc.
- Injury: any blunt or penetrating injury may fracture vertebrae, damage discs, or otherwise damage the spine enough to cause pressure on the spinal cord
- Cancerous growths: bone cancers and spinal tumors
Less Common Causes
Less common causes of myelopathy include:
- Inflammation within the spinal column. Inflamed tissues swell and heat, due to the increased blood flow and immune system activity they cause. Autoimmune diseases (such as multiple sclerosis) and rheumatoid arthritis are examples of inflammation-sourced myelopathy.
- Similarly to the body’s inflammatory response, the immune response also increased blood flow to affected areas. Should an infection take hold in the spinal cord, or the membranes surrounding it, the resultant swelling may cause compression on the cord.
- A hernia is, medically speaking, the leaking of one tissue through its surrounding membrane into the surrounding tissue.
- A cyst is a fluid-filled bump that generally develops in response to friction, infection, or clogging of a gland. They may develop anywhere in the body, including within the spinal column.
- Fundamentally, a hematoma is a bruise, but it can form anywhere in the body. Medically speaking a hematoma is the result of a blood vessel rupturing (due to injury or decay) and leaking into the surrounding tissue, resulting in swelling.
- Genetic predisposition. Sometimes, myelopathy is simply the result of the genetic happenstance. Some people may be more likely to develop it than others.
What Are the Signs and Symptoms of Myelopathy?
The precise location of the actual myelopathy will determine the specific signs and symptoms that will occur. With 33 vertebrae and 25 discs in the human spine, all of them are susceptible to the damage or degeneration that may result in myelopathy; the range of effects is very broad.
Common to all people suffering from myelopathy are the following signs and symptoms:
- Pain or discomfort
- Loss of sensation, function, or movement
- Tingling, prickling, or numbness, along with feelings of being “shocked” or “electrified”
- Difficulties with balance and movement, both fine and gross (for example, writing and walking)
- Reflexes that are increased, exaggerated, or otherwise abnormal
- Movements that are sudden, spasmodic, and irregular
All of these, as well as the site-specific signs and symptoms of myelopathy, will increase and intensify over time without treatment. Prompt identification and medical treatment is essential in preventing the condition from advancing to direct damage to the spinal cord, which is inoperable with current medical technology.
Types of Myelopathy
The specific type of myelopathy being experienced depends entirely on its location in the spinal cord: in the neck area (cervical), chest (thoracic), or lower back (lumbar). Medical professionals may diagnose myelopathy by locating the actual compression point, which will be at or just above the area where the pain begins in the patient’s back.
Cervical Myelopathy. In cervical or neck myelopathy, the compression point will be located within the first five vertebrae of the spine, just below the skull. Cervical myelopathy is the most common type of myelopathy. Associated signs and symptoms will, in addition to those listed above, include the following:
- Pain, tingling, numbness or weakness in the neck, shoulders, and arms
- Difficulty with fine motor skills, such as writing or buttoning a shirt
- Difficulty turning the head or bending the neck
- Lightheadedness
- Difficulties with hand-eye coordination
Thoracic Myelopathy. The chest, or upper back, is called the thoracic region, physically the largest and longest portion of the spine. Most myelopathies in this area are caused by herniated discs, bone spurs, or external injury. Among the characteristic symptoms of thoracic myelopathy are:
- Difficulty walking and balancing on two feet
- Weakened legs
- A sense of having abnormally heavy legs
- Loss of ability to move quickly
- Loss of urinary or bowel control
- Changes in sexual functioning
Lumbar Myelopathy. This is the least likely location for myelopathy to develop. Physically, the spinal cord ends at the top of this lower portion of the spine, making problems in this area only possible if the patient has an unusually long spinal cord, or other physiological features making the spinal cord vulnerable to myelopathy.
What Are the Risk Factors for Myelopathy?
Many factors have been identified as raising the risk factors for developing myelopathy. These include the following:
- Age (the elderly are especially likely to encounter myelopathy)
- Smoking
- Alcohol
- Obesity
- Sports, especially intense, high impact sports including football, gymnastics, track and field, etc.
- Sedentary lifestyle (low exercise)
- Occupation, specifically, intensive manual labor that requires repeated movements putting heavy stress on the back
- Lifting heavy objects without properly engaging the legs and back
If you or a loved suspects that they are suffering from Myelopathy and would like to learn more about this diagnosis and treatment options, call Coastal Orhtopedics today at (361) 994-1166.
Article written by: Rob Williams, MD
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