Cervical myelopathy

What it is

Cervical myelopathy means that the spinal cord in the neck is not functioning normally because it is being compressed. Changes may involve the hands, balance, walking, or several areas at once.

Symptoms can remain stable for a time or worsen. Because lasting nerve damage can occur, suspected myelopathy needs a clinical assessment and a plan for treatment or monitoring.

What it feels like

• Clumsiness with fine tasks — buttons, coins, handwriting, doing up a necklace.
• Dropping objects, or hands that feel unreliable rather than weak.
• Unsteadiness walking, a wider stance, or a sense of walking on uneven ground.
• Heaviness in the legs, and occasionally changes in bladder urgency.
• Neck pain may be mild or entirely absent.

How it is assessed

Examination looks for brisk reflexes and specific signs of cord involvement, along with gait and balance testing. MRI shows the degree of compression and whether the cord itself has changed signal.

Treatment

For mild myelopathy, surgery or a supervised programme of non-operative care with close follow-up may be discussed. Surgery is generally recommended for moderate or severe myelopathy, or neurological deterioration.

The choice between an anterior operation, laminoplasty, and posterior decompression with fusion depends on where the compression is, the alignment of the neck, and other individual factors.

Surgery aims to protect spinal cord function and may improve symptoms. Recovery varies, and some symptoms can remain even after the pressure has been relieved.