Wear or herniated discs in the cervical spine can lead to degenerative limitations of the spinal cord with neurological deficits. Doctors speak of a myelopathy.
What is myelopathy?
The medical term myelopathy or cervical myelopathy is made up of the Greek words “myelon” = spinal cord and “pathos” = pain and stands for damage to the spinal cord in the spinal column. See sciencedict for Introduction to Dermatomyositis.
Damage to the spinal cord can lead to a number of complaints such as unsteady gait, numbness and other neurological problems.
The cervical spine is most commonly affected, but myelopathy can occur elsewhere in the spine.
Causes
The main cause of myelopathy is a narrowing of the spinal cord, which can be congenital but in most cases is acquired over the course of life. The degenerative changes that lead to myelopathy can be of a traumatic nature and be triggered by accidents or falls, but they can also result from inflammation, tumor diseases or post-surgical changes such as scarring.
In most cases, myelopathy is caused by degenerative changes and wear and tear in the affected area of the spine. They constrict the spinal cord and irritate the nerve roots. Various types of herniated discs can also lead to stenosis of the spinal cord.
Symptoms, Ailments & Signs
Typical symptoms of myelopathy are neck pain that radiates into the arms, sometimes also numbness and a feeling of weakness in the arms. Arms and hands can fall asleep at night. A first sign may be a stiff neck and limited ability to turn the head to the left or right.
If the spinal cord is already damaged, the symptoms can also spread to the legs and lead to unsteadiness when walking and impairment of the bladder and bowels. An important identifying feature is the feeling of an electric shock that can occur when the head is bent (Lhermitt’s sign). The further the disease has progressed, the more neurological deficits can occur. These include pins and needles, tingling, pain, lumbering, problems with coordination, and problems with everyday activities such as tying your shoes or putting on a jacket. In severe cases, it can lead to paralysis, bladder, bowel anderectile dysfunction occur.
Diagnosis & course of disease
The most important way to diagnose myelopathy is magnetic resonance imaging (MRI). It most clearly depicts degenerative changes with pressure on the spinal cord. If extensive ossification needs to be treated, computed tomography (CT) is an indispensable tool for visualizing the bones in order to be able to better plan and assess the surgical procedure.
In order to prevent an unfavorable course in good time, it is important to diagnose the disease as early as possible. In patients with acute symptoms after a herniated disc, the chance that the symptoms will subside is greatest if the herniated disc is diagnosed immediately. Bone changes can occur slowly and insidiously, and are sometimes not noticed immediately or associated with other problems.
Degenerative changes in the cervical spine with changes in the cervical spinal cord can be easily recognized in an MRI scan. Treatment of myelopathy depends on the extent of the damage.
Complications
Myelopathy causes severe neurological deficits in the patient. These failures can lead to paralysis and other sensory disturbances and thus significantly reduce the patient’s quality of life. Movement restrictions continue to occur, so that patients may need help from other people in their everyday lives. Those affected suffer primarily from severe pain in the neck and also from a stiff neck.
This causes pain when turning the head. There are also problems with coordination and concentration. The pain can restrict everyday life and, in the form of pain at rest, can also lead to sleeping problems at night. It is not uncommon for myelopathy to also lead to problems with potency.
The bowel and bladder are also affected by the disease. It is not uncommon for those affected to develop psychological symptoms as well. The life expectancy of the person affected by the myelopathy may also be limited by the underlying disease. In many cases, the damage is irreversible, so no treatment can take place.
However, various therapies can alleviate the symptoms. In most cases, however, the myelopathy does not heal completely. Other complications usually do not arise during the treatment.
When should you go to the doctor?
Pain in the back or cervical spine should always be checked out by a doctor. If the symptoms have existed for a long time and become worse over time, there may be a serious illness such as myelopathy, which must be medically diagnosed and therapeutically treated. Affected people are best advised to consult their family doctor. This can make an initial diagnosis and, if necessary, refer the patient to an orthopedist.
The actual treatment is carried out by various specialists and a physiotherapist. Depending on the severity of the disease, surgical measures must also be initiated. People who already have a back condition are particularly at risk of developing myelopathy. Older people and people with deformities in the area of the back or spine are also among the risk groups and should speak to a doctor at an early stage. The therapy is lengthy and the patient has to be examined regularly so that complications can be ruled out and, if necessary, treated immediately. In addition, a regular adjustment of the medication is necessary.
Treatment & Therapy
In most cases, conservative treatment does not help sufficiently because the cause, the contusion of the spinal cord, is not eliminated. Bruises of the spinal cord and changes in the bones usually do not go away on their own. A herniated disc can regress and does not always have to be operated on, but it takes a lot of time.
If the incident caused spinal cord damage, however, surgery is required or the symptoms will not go away. Conservative therapy can sometimes be necessary if patients cannot be operated on because of their advanced age or comorbidities. It involves the administration of pain-relieving, decongestant, and anti-inflammatory drugs. If necessary, a neck brace and bed rest must be prescribed.
If there is no pain, physical therapy will help stabilize the cervical spine. During conservative treatment, the course must be closely monitored in order to quickly identify possible deterioration. If there are neurological impairments or failures, an operation to relieve the spinal cord is unavoidable. The procedure must always be performed in hospital. Before the operation, infusions or medication are used to induce swelling of the spinal cord.
When anesthetizing, care must be taken to avoid overstretching the head when positioning the patient so as not to squeeze the spinal cord even more. The operation is usually performed from the front, but if the findings are appropriate, it can also be performed from the back. After the operation, decongestants are still required for several days. This is usually followed by a rehabilitation measure with exercises to reduce the symptoms. They often cannot be completely healed.
Outlook & Forecast
The outlook for myelopathy is mixed. In principle, the best chances of recovery exist with an early diagnosis and a subsequent start of therapy. In practice, however, it usually proves to be problematic that the disease progresses insidiously. There are no adequate early detection signals. As a result, neurological deficits and changes in the bones can no longer be corrected. Doctors therefore often speak of an insidious nature of myelopathy. The quality of life suffers. The progressive form leads to increasing symptoms if left untreated.
Acute myelopathy usually brings with it the chance that the symptoms will completely resolve. The medical effort is low depending on the basic condition of the patient. If tumors or other diseases trigger the myelopathy, the success of the treatment depends crucially on combating these causes.
A rehabilitation period of several weeks usually follows after an operation. If necessary, stress restrictions in everyday life must be accepted. A back-friendly behavior and a strengthening of the muscles are essential. Some patients are dependent on aids for the rest of their lives if the course is severe. If necessary, permanent supervision may be necessary.
Prevention
As with most spinal diseases, myelopathy can be effectively prevented by avoiding one-sided movements and chronic poor posture. People who work in an office and have to sit at a desk and computer a lot should do exercises to relieve the cervical spine on a regular basis.
Regular physical exercise strengthens the back muscles and alleviates back problems. In the case of minor complaints, physiotherapy exercises help to prevent chronic poor posture in good time and to relieve the spine.
Aftercare
In most cases, patients with myelopathy have only very limited and very few direct follow-up measures available. The affected person should therefore consult a doctor at an early stage so that other complications and symptoms do not occur. The sooner a doctor is consulted, the better the further course of the disease.
In the case of a desire to have children, the person concerned should first consider genetic testing and counseling to prevent the disease from recurring in the children. Most of those affected are dependent on the measures of physiotherapy or physiotherapy in the case of myelopathy. Many of the exercises can also be performed at home.
Many sufferers are dependent on taking various medications. The person concerned should always rely on a correct dosage and also on regular intake. If anything is unclear or if you have any questions, the person concerned should always contact a doctor first in order to avert any complications and symptoms in advance.
You can do that yourself
What measures myelopathy patients can take in everyday life depends on the cause and severity of the disease. If there is only a herniated disc, the symptoms can be alleviated by professionally instructed physiotherapy. The patient can support the therapy at home with individual exercises. Moderate exercise will help keep the disc from slipping out again.
If an operation is necessary, the person concerned primarily needs rest. The procedure usually puts a lot of strain on the spine, which is why strenuous physical activities should be avoided in the first day after the operation. If necessary, the patient must wear a neck brace and walk with crutches at the beginning. If pain occurs, a relatively strong painkiller must be used to avoid incorrect posture and the resulting damage. The patient can support the medication with various means from naturopathy. In addition to valerian drops, preparations such as arnica or devil’s claw have also proven their worth. A hot bath helps with acute pain.
In parallel with these measures, a doctor must monitor the course of the disease. If complications arise, the doctor must be informed. Myelopathy may be due to a tumor or inflammation that needs to be treated first.