Summary

Myelopathy is a condition characterized by dysfunction or damage to the Spinal Cord, a crucial component of the central nervous system responsible for transmitting sensory and motor signals. Myelopathy can stem from factors like compression, inflammation, trauma, and other conditions, leading to a range of neurological symptoms. Symptoms can include muscle weakness, sensory changes, difficulty walking, pain, reflex loss, bowel/bladder dysfunction, and sexual dysfunction. Diagnosis involves medical history, physical exams, and tests such as imaging and electrophysiological studies. Treatment options depend on the cause and severity and can involve conservative management (physical therapy, pain relief), surgical intervention (decompression, fusion), or bracing. Seeking medical guidance is crucial for optimal management.

What is Myelopathy?

Myelopathy refers to a condition that involves damage or dysfunction of the Spinal cord. The spinal cord is a crucial part of the central nervous system, extending from the base of the brain down through the vertebral column. It is responsible for transmitting sensory information, motor signals, and other nerve impulses between the brain and the rest of the body.

When the spinal cord is compromised due to various factors, myelopathy can occur.

Causes of Myelopathy

Myelopathy can be caused by various factors that lead to damage or dysfunction of the spinal cord. These causes can be broadly categorized into several groups:

• Spinal Cord Compression: Pressure on the spinal cord is one of the most common causes of myelopathy. This compression can result from various factors, including herniated discs, tumors, and spondylosis. 
• Trauma: Injuries to the spine, such as falls, car accidents, or sports-related injuries, can directly damage the spinal cord and lead to myelopathy.
• Inflammatory Conditions: Inflammation of the spinal cord can occur due to autoimmune disorders, infections, or other inflammatory diseases, leading to myelopathy. Conditions like multiple sclerosis and transverse myelitis fall into this category.
• Vascular Issues: Reduced blood flow to the spinal cord due to conditions like spinal cord infarction or arteriovenous malformations can cause ischemia (lack of blood supply) and subsequent myelopathy.
• Infections: Infections that affect the spinal cord, such as spinal abscesses, tuberculosis, or viral infections like herpes zoster, can lead to inflammation and damage.

Symptoms of Myelopathy

The symptoms of myelopathy can vary widely depending on the underlying cause, the location of the spinal cord damage, and the severity of the condition. Common symptoms of myelopathy include:

• Weakness: Muscle weakness is a common symptom of myelopathy. This weakness may affect one or both sides of the body and can lead to difficulty with activities that require strength and coordination, such as walking, lifting objects, or performing fine motor tasks.
• Pain: Depending on the location and extent of the spinal cord damage, individuals with myelopathy may experience various types of pain, such as neck or back pain or pain radiating to the arms or legs. 
• Sensory Changes: Myelopathy often leads to sensory disturbances, including numbness and tingling.
• Difficulty Walking: Myelopathy can impact an individual’s ability to walk normally. Balance problems, unsteady gait, stumbling, and a feeling of weakness in the legs can contribute to difficulties with walking.
• Bowel and Bladder Dysfunction: In severe cases of myelopathy, individuals may experience difficulty controlling their bowel and bladder functions, leading to incontinence or retention.
• Sexual Dysfunction: Myelopathy can impact sexual function due to disruption of the nerve pathways involved in sexual response.

Diagnosing Myelopathy

Diagnosing myelopathy involves a combination of medical history evaluation, physical examination, and various diagnostic tests. Some of the tests used to diagnose myelopathy are reviewed below.

Imaging Studies

Diagnostic imaging plays a crucial role in identifying the location and extent of spinal cord damage. Common imaging tests include:

• Magnetic Resonance Imaging (MRI): This non-invasive imaging technique provides detailed images of the spinal cord and surrounding structures. MRI can reveal issues such as herniated discs, spinal stenosis, tumors, or other abnormalities.
• Computed Tomography (CT) Scan: CT scans can provide cross-sectional images of the spine, helping to identify bone abnormalities, fractures, or spinal cord compression.
• Myelogram: A myelogram involves injecting a contrast dye into the spinal canal and taking X-rays to visualize the spinal cord and nerves. This test can help identify areas of compression or blockage.

Electrophysiological Tests

Electrophysiological tests assess the function of nerves and muscles. These tests can help determine the location and severity of nerve damage. Common tests include:

• Electromyography (EMG): EMG measures electrical activity in muscles to evaluate nerve and muscle function.
• Nerve Conduction Studies (NCS): NCS measures the speed at which nerves transmit electrical signals, helping to identify nerve damage or dysfunction.

Treatment of Myelopathy

The treatment for myelopathy depends on the underlying cause, the severity of symptoms, and the individual’s overall health. Some treatment options include:

Conservative Management

Mild cases of myelopathy may be managed conservatively, especially when the symptoms are not severe and there is no imminent risk to spinal cord function. Conservative approaches can include:

• Physical Therapy: Physical therapy aims to improve muscle strength, flexibility, and coordination. Therapists can design customized exercise programs to target specific muscle groups and alleviate symptoms.
• Pain Management: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or other medications may be prescribed to manage pain and muscle spasms.

Surgical Intervention

Surgical treatment may be necessary when conservative measures are ineffective or when there is significant spinal cord compression that requires immediate attention. Surgical options can include:

• Decompression Surgery: This involves removing structures that are compressing the spinal cord, such as herniated discs, bone spurs, or tumors. Techniques like discectomy or laminectomy may be used.
• Spinal Fusion: In cases of instability or deformity, spinal fusion may be performed to stabilize the spine. This involves fusing two or more vertebrae together using bone grafts or hardware.
• Tumor Removal: If a tumor is causing myelopathy, surgical removal (tumor resection) may be necessary to alleviate compression and restore spinal cord function.

The choice of treatment depends on multiple factors, and it’s important to consult with a healthcare professional to determine the most suitable approach. 

The Takeaways

Myelopathy is a condition characterized by dysfunction or damage to the spinal cord, a crucial component of the central nervous system responsible for transmitting sensory and motor signals. Myelopathy can stem from factors like compression, inflammation, trauma, and other conditions, leading to a range of neurological symptoms. Symptoms can include muscle weakness, sensory changes, difficulty walking, pain, reflex loss, bowel/bladder dysfunction, and sexual dysfunction. Diagnosis involves medical history, physical exams, and tests such as imaging and electrophysiological studies. Treatment options depend on the cause and severity and can involve conservative management (physical therapy, pain relief), surgical intervention (decompression, fusion). Seeking medical guidance is crucial for optimal management.

Sources

Oyinkan Marquis B, Capone PM. Myelopathy. Handb Clin Neurol. 2016;136:1015-1026. 

Sechi E, Flanagan EP. Evaluation and Management of Acute Myelopathy. Semin Neurol. 2021;41(5):511-529.

Donnally III CJ, Hanna A, Odom CK. Cervical Myelopathy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 15, 2023.

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