Cervical Myelopathy & Radiculopathy
Cervical myelopathy describes a loss of function in a person’s upper and lower extremities because of compression of the spinal cord within the neck.
Cervical radiculopathy describes the loss of function in a specific region in the upper extremities that is secondary to compression and/or irritation of a spinal nerve root in a patient’s neck.
What Are the Symptoms?
Cervical myelopathy may present subtly at first, causing slight changes in the way a patient’s hands work—a patient may feel their hands being clumsier, or their handwriting worsens, or may find themselves dropping things or finding it harder to button their shirts. Other symptoms may include:
- Unsteady gait
- Loss of sense of body consciousness, where hands and feet are relative to things around them
In extreme cases, symptoms may include:
- Pronounced weakness and numbness in arms and legs
- Loss of bladder or bowel control
Cervical radiculopathy presents as pain traveling from the neck to a particular region of a patient’s arm, forearm or hand. This may be accompanied by numbness or weakness in specific muscle groups in the arm, forearm or hand.
What Treatments Are Offered?
Nonsurgical treatments are commonly used with cervical radiculopathy, including ergonomic adjustments at home or work, use of over-the-counter anti-inflammatory medicines.
Ice or heat, applied to the impacted area may bring temporary relief. Prolonged bed rest is usually not recommended, as it can make things worse in time.
If this does not control the pain, other, stronger medications can be used, including:
- Prescription anti-inflammatory medicines
- Muscle relaxants
- Narcotic painkillers
Physical therapy, emphasizing stretching and flexibility may be used to help with pain relief.
In time, moderate strength-building exercises may be included to help a patient recover. This therapy can help a patient avoid secondary inflammation in the extremities as a response to the primary impacted area.
Use of epidural steroid injections may be encouraged by your doctor in an effort to treat the inflammation of cervical radiculopathy. These injections would be applied into the area around the neck to reduce inflammation and impact on the affected nerve.
Other lifestyle changes, such as avoiding behaviors and activities that might put greater strain on neck or spine, may be recommended.
Occupational therapists may be able to help by suggesting other ways to undertake routine tasks that don’t put excessive strain on the affected region.
In some cases, patients may find nonsurgical procedures do not bring relief, and in these situations, surgery may provide an opportunity for treatment.
Like with most spine-related procedures, there are two common approaches:
- Anterior (frontal)
- Posterior (back)
Whether your surgeon uses the anterior or posterior approach depends on the precise location of your condition, as well as your overall health, and the severity of the disorder.
With the anterior approach, a small incision is made in the front of the neck, and tissues are carefully moved aside to give the surgeon access to the cervical vertebrae.
The afflicted area will be repaired, and, as necessary, bone may be inserted to the space, and/or plates and screws, known as hardware. A neck brace is likely to be given after surgery, for a short period of time, to aid in recovery.
In the posterior approach, a small incision is made directly over the affected region, and precision tools used to remove the impacted bone to relieve pressure on the nerve(s).
In cases where there is compression in a wider area than simply the neck, other procedures such as laminectomy or laminoplasty may be performed to treat it.