I have had a patient on and off for years who has a neurological condition that affects her feet. She is in her early 70s and does quite well even with her challenges. Her neurologist decided to do a MRI on her neck. I was shocked at the results. It showed severe cervical myelopathy. My patient was not having any symptoms that we were aware of but this could become a debilitating condition. She was not sure if she wanted to do surgery but eventually decided to go ahead with it. She recovered quite well with no lasting effects from the surgery or the cervical myelopathy. Read on to learn more about cervical myelopathy. Let’s start with anatomy!
The spine
In order to understand cervical myelopathy, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. Each vertebrae stacked on top of one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar, which is also known as the low back. The next five make up the sacrum which is the triangular bone at the base of the spine. The sacral vertebrae are fused meaning they have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. The discs are in between the cervical, thoracic, and lumbar vertebrae. The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.
The cervical spine
The cervical spine is made up of 7 unique vertebrae (spinal bones). It’s job is to support and soften loads to the head and neck while allowing movement. It also functions to protect the spinal cord. The cervical vertebrae are named C1 through C7. C1 is the first vertebrae below the skull and C7 is the last vertebrae of the cervical spine.
The cervical spine has 8 cervical nerve roots. These nerve roots come off of the spinal cord and travel between the vertebrae at each level. The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands. Each nerve root innervates a different area of the body.
Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to function smoothly. These include joints between the vertebrae which allow movements and several ligaments which add stability to the spine.
What is cervical myelopathy?
Cervical myelopathy is a condition in which there is compression of the spinal cord at the cervical spine. Because it is the spinal cord and not the nerve root that is compressed, cervical myelopathy can cause symptoms in all areas of the body below the neck. There are several causes of cervical myelopathy. These include:
- Degenerative changes in the cervical spine (cervical spondylosis)
- This is the most common cause.
- This is also known as cervical spondylotic myelopathy.
- This can include degenerative changes in any or all the structures of the cervical spine including discs, ligaments, and bone spurs at the joints between the vertebrae.
- This tends to be a progressing condition and can lead to paralysis if left untreated.
- Congenitally narrow spinal canal
- This increases the risk for cervical myelopathy.
- Instability of the cervical spine
- This is the inability to maintain normal cervical spinal alignment because of decreased structural stability at the cervical spine.
- Spinal cord tumor
- A growth could be causing compression to the spinal cord.
- Spinal infections
- This can cause swelling in the spinal canal.
- Whiplash or other neck injury
Who gets cervical myelopathy?
Because the most common cause of cervical myelopathy is degeneration of the cervical spine, it mostly affects adults 55 years and older. Some cervical myelopathy is present in about 90% of adults by the time they reach 70. However this does not mean that they are at levels that are problematic or symptomatic.
Cervical myelopathy affects men and women equally. However men tend to have degenerative changes in the cervical spine earlier than women.
What are the symptoms of cervical myelopathy?
There are several symptoms associated with cervical myelopathy. These include:
- Early symptoms include hand clumsiness, numbness and/or pain in the hands
- This includes difficulty buttoning shirt, fixing hair, or holding small objects
- Other symptoms include
- Neck pain and stiffness
- Difficulty looking up
- Shoulder and shoulder blade pain
- Pins and needles sensation in one or both arms or hands
- Symptoms of long-term involvement include
- Increased tendon reflexes
- Bowel and bladder dysfunction
- Unsteady or clumsiness when walking
- General weakness
Do I need surgery?
The answer is maybe. If the condition is progressing, is already severe, or is causing severe pain or disability, then surgery would likely be the next step. If the condition is mild with no symptoms, then surgery might not be needed. However, surgery has better outcomes if it is performed earlier rather than later from the onset of symptoms.
Who should I see?
- Orthopedic spine specialist or neurosurgeon – You need to first get imaging to determine the severity of the cervical myelopathy. This will most likely be a MRI. Your doctor will discuss if surgery is recommended at this time. Even if surgery is not recommended, it is good idea to have regular appointments and imaging in order to keep track of the status of the condition.
- Physical therapy – Physical therapy will probably be needed whether or not surgery is required. Physical therapy can help strength, coordination, and mobility issues in the neck or other areas of the body. Treatment could include joint mobilization or manipulation, soft tissue mobilization, dry needling, stretching, strengthening, balance and gait training. Your PT should be able to help decrease your pain while helping to improve your mobility, posture, and strength.
What can I do?
- Aerobic – Performing low impact aerobic exercise is very beneficial for the spine. It increases the flow of nutrients and blood. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one. You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months. Be sure that whatever type of exercise you choose does not exacerbate your symptoms.
- Ice – Ice can help decrease pain in the neck, shoulder, or upper back. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Posture – Having forward rounded shoulders causes the chin to poke forward and the neck to forward flex. This takes the cervical spine out of it’s natural alignment. If the pectorals and biceps are tight, they will cause the shoulders to round. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Strengthen and stretch the muscles around the cervical spine – Strengthening the deep neck flexors are vital in strengthening the neck and being able to maintain proper posture. The deep neck flexors are attached to the vertebrae and are the key stabilizers of the cervical spine. The upper trapezius and levator scapula are muscles that attach to the neck and shoulder. These muscles are commonly tight and can cause neck pain and headaches. Below is a video on how to strengthen the deep neck flexors and stretch the upper trapezius and levator scapula.
- Strengthen the scapular stabilizers –The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. They are also very important in maintaining good posture. Activating these muscles will help properly align the thoracic spine which will help with proper posture of the cervical spine. The videos below review some strengthening exercises for the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
- Lower body and core exercises – It is important to strengthen the legs and core to help with balance and stability while walking and standing.
- Balance exercises – Working on balance can help your ability to walk and perform other activities safely. Cervical myelopathy can cause unsteadiness and an increase risk of falling. Below is a video reviewing a few balance exercises.
- Latex pillow – There has been some research showing that an ergonomic latex pillow can help decrease neck pain. The pillow can support the spine and the head which can improve sleep and decreased pain.
In review
- The cervical spine is made up of 7 unique vertebrae (spinal bones).
- It’s job is to support and soften loads to the head and neck while allowing movement.
- The cervical spine has 8 cervical nerve roots.
- The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands.
- Each nerve root innervates a different area of the body.
- Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to smoothly function.
- Cervical myelopathy is a condition in which there is compression of the spinal cord at the cervical spine.
- Degenerative changes in the spine is the main cause of cervical myelopathy.
- Symptoms include neck stiffness and pain, hand clumsiness, and unsteadiness when walking.
- Surgery could be necessary depending on the severity and how quickly the condition is progressing.
- You would need to see a neurosurgeon or an orthopedic spine specialist.
- Physical therapy would be needed whether surgery is required or not.
- There are things that you can do.
- Aerobic exercise
- Ice
- Posture
- Strengthen and stretch neck muscles
- Strengthen scapular stabilizers
- Lower body and core exercises
- Balance exercises
- Latex pillow
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Cervical_Myelopathy
https://www.ncbi.nlm.nih.gov/books/NBK482312/