What causes cervical myelopathy?
The most common cause is degenerative cervical myelopathy: arthritis, disc bulges, bone spurs and thickened ligaments gradually narrowing the canal (cervical stenosis). Large disc herniations, ossification of the posterior longitudinal ligament (OPLL), and spinal injury can also compress the cord.
Warning signs
- Clumsy hands, dropping objects, trouble with buttons, jewelry clasps or handwriting
- Numbness in the hands that doesn't follow a single nerve pattern
- Unsteady walking, needing to hold walls or rails
- Electric sensations down the spine when bending the neck
- In advanced cases, bladder urgency
Neck pain may be mild or absent, so these symptoms are easily mistaken for aging, arthritis or carpal tunnel syndrome.
Diagnosis
Dr. Ferachi looks for specific exam signs of cord involvement, including brisk reflexes, Hoffmann's sign and gait changes. MRI shows the level and degree of compression and any signal change within the cord.
Treatment
Because myelopathy is usually progressive and cord damage may be permanent, surgery is recommended for most patients with moderate or worsening symptoms. The goal is to stop progression and, often, improve function. Depending on the number of levels and your alignment, Dr. Ferachi may recommend an anterior approach (ACDF or corpectomy) or a posterior approach (laminectomy and fusion or laminoplasty).
Common questions
Can cervical myelopathy be treated without surgery?
Very mild, stable myelopathy may be monitored closely. However, physical therapy and injections do not relieve cord compression, and guidelines recommend surgery for moderate, severe or progressing cases.
Will my symptoms go away after surgery?
Surgery's main goal is to halt progression. Many patients also see improvement in hand function and balance, but long-standing deficits may not fully recover, which is why timely treatment matters.