Cervical Myelopathy: Progression, Causes, Outlook, and More
This article explains cervical myelopathy, including its symptoms, causes, and when to contact a doctor. It also discusses treatments and outlook for the condition and answers some frequently asked questions.
Your spinal cord delivers nerve impulses to multiple regions in your body. Because of this, compression in this area can lead to a range of symptoms.
Cervical myelopathy mostly affects the upper body, but can also affect other areas. Symptoms can include:
- weakness or numbness in the hands or arms
- general weakness
- stiffness or reduced range of motion
- clumsiness, or loss of balance or coordination
- spasticity, or muscle contractions
- difficulty with fine motor tasks, such as:
- buttoning clothes
- holding small items
- neck pain
- changes in bowel or bladder function
- Lhermitte’s sign, a sensation of pain when moving your neck to certain positions
Learn more about Lhermitte’s sign symptoms and causes.
Onset of cervical myelopathy symptoms is usually gradual and can take several years to develop. However, some people may experience a rapid progression of symptoms.
If you experience symptoms in the lower part of your body, you may notice weakness or gait changes. This can include walking with your feet wider apart.
Clinicians sometimes use a classification system to monitor the stages of cervical myelopathy. These stages are organized by specific sets of symptoms.
Cervical myelopathy stages can include:
|0||You have no symptoms affecting the nerve root or spinal cord.|
|1||You have no symptoms involving the spinal cord, but may have symptoms affecting the nerve root. Symptoms can include partial paralysis and changes in reflexes and senses.|
|2||Clinicians may see signs involving spinal cord, but your walking gait is unaffected.|
|3||Your walking gait starts to be affected, but you may be able to do daily tasks or work.|
|4||At this stage, changes to your mobility may further decrease your ability to work or perform daily tasks.|
|5||You may require a wheelchair or be unable to stand or move around independently.|
Contact your doctor promptly if you notice any symptoms of cervical myelopathy. You should also contact your doctor for any symptoms that affect your quality of life or ability to perform daily tasks.
If you experience any sudden or severe symptoms, such as sudden pain, numbness, or inability to move, seek emergency medical care or call 911.
The cervical region, or cervical spine, consists of seven vertebrae, or spinal bones, at the base of the neck. These vertebrae rest on top of one another with discs acting as a cushion between them. Over time, these discs can degrade and cause compression in your spinal cord.
Degradation of spinal discs can occur due to a variety of factors, such as:
- herniated discs
- bone spurs
- neck or spinal cord injury, due to factors such as:
- neck or spinal cord infection
- spinal cord cancers
- different types of arthritis, such as:
- rheumatoid arthritis (RA)
Some factors may increase your risk of developing cervical myelopathy. These include being over the age of 55 and being born with a narrower spinal canal.
Research also suggests that people of Asian descent may be more likely to develop cervical myelopathy. This may be due to hardening of the posterior longitudinal ligament, which connects the bones of the spinal column. When calcium deposits cause this ligament to harden, it can lead to cervical myelopathy.
Rheumatoid arthritis (RA) can also be a risk factor for cervical myelopathy. However, a 2020 literature review suggests that only around 2.5% of participants who had RA for over 14 years experienced cervical myelopathy.
Learn more about RA, including treatments and outlook.
To make a diagnosis, your doctor may start by asking about your symptoms and medical history. They may then perform exams to check your:
- pain levels
Your doctor may also recommend imaging scans such as MRIs or X-rays to confirm the diagnosis.
Treatment for cervical myelopathy typically involves therapies to manage the condition. These are aimed at addressing pain and inflammation and improving mobility and quality of life.
Cervical myelopathy therapies can include:
- anti-inflammatory medication
- physical therapy
- corticosteroid injections, in some cases
- surgery, such as:
- anterior cervical discectomy and fusion (ACDF) to replace damaged discs with grafts
- laminectomy, which removes bone spurs
Surgery also aims to increase the canal space and decrease spinal cord compression. For people who are eligible, it may be beneficial to receive surgery sooner rather than later.
Cervical myelopathy can carry a risk of complications, such as:
- pain and reduced mobility due to ineffective treatment
- nerve injury
- breathing difficulties in rare cases, which may lead to aspiration or pneumonia
- surgical complications, such as:
Anterior cervical discectomy and fusion (ACDF) surgery can also lead to complications. According to a 2022 overview, around 3% of people experience laryngeal nerve palsy after ACDF surgery. This can cause vocal cord paralysis and voice changes.
The outlook for people with cervical myelopathy can vary based on individual factors.
Factors associated with a more negative outlook may include:
- symptoms that last for more than 18 months
- decreased range of motion in the cervical spine
- being assigned female at birth
It should be noted that these factors are estimations based on previous medical studies.
Effective treatment can improve your symptoms and quality of life, and slow the progression of cervical myelopathy. It can also reduce your risk of complications.
Contact your doctor for individualized advice about your treatment and outlook.
Seunggu Han, M.D., has reviewed the following frequently asked questions about cervical myelopathy.
What is cervical spondylotic myelopathy?
Cervical spondylotic myelopathy, or cervical spondylosis with myelopathy, is an arthritic type of cervical myelopathy. It occurs due to the wear and tear of discs and joints in the cervical spine. It may cause bulging spinal discs, bone spurs, or overgrown ligaments, which cause pressure on the spinal cord. This can lead to myelopathy.
Is cervical myelopathy serious?
Cervical myelopathy can be serious. Without early or effective treatment, you may experience effects such as pain, paralysis, and loss of mobility.
What are the early signs of degenerative cervical myelopathy?
Early symptoms of degenerative cervical myelopathy can include:
- loss of mobility
- changes in reflexes and senses
- lack of coordination
Why does cervical myelopathy affect the legs?
Your spinal cord contains nerve tissue that travels to and from the legs. Because cervical myelopathy affects the health of the spinal cord, it can also affect your legs. This can occur when the condition damages the nerves that communicate with the lower body.
Cervical myelopathy refers to the compression of the spinal cord in your neck. This can occur due to the discs between your vertebrae wearing down, such as from injury or arthritis.
Cervical myelopathy symptoms can include neck pain, loss of coordination, and difficulty walking. Without treatment, these symptoms may progress.
Therapies such as surgery and physical therapy can help treat cervical myelopathy. They can help to improve your mobility and quality of life.
Contact your doctor promptly for any gradual symptoms of cervical myelopathy. Seek emergency care for sudden symptoms of severe pain or paralysis.