Cervical Myelopathy Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Cervical Myelopathy?

Cervical myelopathy is a condition affecting the spinal cord within the neck region, potentially causing sensations such as discomfort or pain. It results from changes in the spinal structures that apply pressure on the spinal cord, disrupting normal nerve signals between the brain and the body.

Causes of Cervical Myelopathy

Cervical myelopathy can be caused by various factors, each leading to pressure on the spinal cord in the neck.

  • Degenerative Changes
    The natural ageing process often causes wear and tear of spinal structures like discs and vertebrae. Over time, this degeneration can lead to spinal cord compression, disrupting nerve signals and leading to symptoms such as pain, numbness, and weakness.
  • Traumatic Injury
    Accidents, falls or other traumatic events can cause immediate or delayed onset of cervical myelopathy symptoms. This sudden spinal cord compression can result in pain, tingling, and difficulty in moving limbs.
  • Spinal Tumours
    Abnormal growths in or near the spinal cord can compress it, leading to cervical myelopathy. These tumours can originate within the spinal cord or spread from nearby areas, causing symptoms that vary based on their location and size.
  • Infections
    Spinal infections such as abscesses or infections from other body parts can lead to inflammation and subsequent spinal cord compression. This may result in pain, weakness, and neurological deficits.
  • Inflammatory Disorders
    Conditions like rheumatoid arthritis or ankylosing spondylitis can cause inflammation and structural changes in the spine, leading to nerve compression and related symptoms.
  • Congenital Anomalies
    Some individuals are born with structural abnormalities in the spine, predisposing them to cervical myelopathy later in life. These anomalies can increase the risk of spinal cord compression and subsequent symptoms​​.

Symptoms and Signs

Cervical myelopathy presents a range of symptoms associated with spinal cord compression in the neck.


  • Pain or Discomfort: Commonly experienced in the neck, arms, or hands.
  • Tingling, Numbness, or Muscle Weakness: These sensations are often a direct result of nerve compression.
  • Decline in Fine Motor Skills: This may manifest as difficulty in performing tasks requiring dexterity, such as fastening buttons or grasping objects.
  • Compromised Walking and Balance: Individuals may experience stumbling and unsteadiness, affecting their mobility.
  • Diminished Coordination and Muscle Spasticity: In advanced stages, coordination may be severely affected, and muscle spasticity may occur.
  • Bowel or Bladder Dysfunction: In severe cases, cervical myelopathy can lead to a disruption in control over bladder and bowel functions​.

Diagnosis

Diagnosing cervical myelopathy involves several steps:

  • Medical History and Physical Examination: Spine specialists begin with a detailed medical history and physical examination. They look for signs of pain, weakness, or sensory changes indicative of cervical myelopathy.
  • Diagnostic Imaging: MRI or CT scans are used to provide detailed views of the spine. These imaging techniques reveal structural abnormalities, disc degeneration, and the extent of spinal cord compression.
  • Electromyography (EMG) and Nerve Conduction Studies: These tests may be employed to evaluate nerve function and identify areas affected by compression.
  • Neurological Assessments: Assessments of motor skills, reflexes, and sensory perception may be used to aid in understanding the impact of the condition.

Non-Surgical Treatment Options

Several non-surgical approaches can be employed to treat cervical myelopathy. These are often considered in mild to moderate cases.

Physical Therapy

This involves exercises and techniques to strengthen muscles, enhance flexibility, and improve posture. Physical therapy is integral in managing symptoms and preventing further complications, focusing on supporting the spine and alleviating pressure on the spinal cord.

Medication

A range of medications is utilised to address different aspects of cervical myelopathy. Pain-relieving medications target discomfort, while anti-inflammatory drugs reduce swelling around the spinal cord. Muscle relaxants help in easing muscle spasticity, and specific neuropathic pain medications address nerve-related pain.

Corticosteroid Injections

For more targeted relief, corticosteroid injections can be administered. These injections reduce inflammation around the affected spinal areas, providing temporary but effective relief from pain and discomfort.

Cervical Collar Brace

In certain cases, a cervical collar brace may be recommended by the spine specialist. This brace provides support to the neck, reducing movement and allowing the spine to rest and heal. It can be particularly useful in cases where motion exacerbates symptoms​​​​.

Surgical Treatment Options

In cases where non-surgical methods are insufficient or the severity of cervical myelopathy is high, surgical intervention may be necessary.

Decompression Surgery

This surgery is performed to address spinal cord compression by removing or reducing structures exerting pressure, such as herniated discs or bone spurs. It is intended to assist in restoring function and alleviating symptoms.

Spinal Fusion

In situations where spinal instability is a concern, spinal fusion surgery may be considered. This procedure involves fusing two or more vertebrae, providing stability to the spine and preventing further compression.

Artificial Disc Replacement

For some patients, especially those where motion preservation is a priority, a damaged disc causing compression can be replaced with an artificial disc. This procedure is utilised to maintain mobility and manage pressure on the spinal cord.

Laminoplasty

As a motion-sparing option, laminoplasty involves the widening of the spinal canal. This procedure is suitable for some patients, depending on their specific condition.

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Prevention Strategies

Although it is not always possible to prevent cervical myelopathy, adopting specific measures may help in reducing its risk.

  • Maintaining a Healthy Weight - Weight should be managed through a balanced diet and regular exercises, as excess weight can increase pressure on the spine.
  • Proper Lifting Techniques to Prevent Strain - When lifting heavy objects, try to bend at the knees, tighten abdominal muscles, and use leg strength to assist in lifting. This helps avoid undue strain on the spine.
  • Regular Exercise - Strengthening the core muscles in the back and abdomen through exercises like crunches, planks, or pilates can provide better support for the spine.
  • Quit Smoking - Smoking has been linked to faster degeneration of spinal discs. Cessation can slow down this process.
  • Maintaining Good Ergonomics and Posture - Maintaining proper posture, especially during long periods of sitting or standing, and adopting good ergonomic practices at work or home can reduce strain on the spine​​​​.
  • Preventing Neck and Spine Injuries - Practising safe sports techniques and wearing seat belts can help avoid traumatic injuries to the neck and spine.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Can Cervical Myelopathy Be Cured?

    Cervical myelopathy treatment focuses on managing symptoms and preventing progression. The potential for a cure largely depends on the underlying cause and the severity of the condition. In some cases, particularly with early intervention and appropriate treatment, improvement and symptom relief can be achieved. Ongoing management with a spine specialist is recommended for optimal outcomes.

    How Long Does Cervical Myelopathy Take to Heal?

    The healing time for cervical myelopathy varies based on the treatment method and the individual’s response to therapy. Non-surgical treatments may offer gradual improvement over weeks or months, while surgical recovery can vary. Post-surgery, rehabilitation can help aid recovery.

    What Exercises Can Help Treat Cervical Myelopathy?

    Specific exercises, under the guidance of a spine specialist, can aid in managing cervical myelopathy. These might include gentle neck stretches, isometric exercises, and activities to strengthen neck and core muscles.

    What Happens if Cervical Myelopathy Is Left Untreated?

    If cervical myelopathy is not addressed, it may lead to a progression of symptoms, potentially resulting in increased pain, weakness, and neurological deficits. Early and consistent management with a spine specialist can help prevent deterioration and improve quality of life.