Myelopathy: Symptoms, Causes, Treatment

What are the symptoms of myelopathy?

Myelopathy refers to a clinical syndrome caused by the compression, injury, or disease of the spinal cord. The symptoms can vary depending on the severity of the condition, the specific location of the spinal cord involvement, and the duration of the compression or damage. Common symptoms of myelopathy may include:

1. Neurological Symptoms:

• Weakness: Patients may experience weakness in the arms, legs, or both. This weakness may manifest in difficulty with lifting, gripping, or coordinating movements.
• Numbness and Tingling: Sensory changes such as numbness, tingling, or “pins and needles” sensations are common, often affecting the arms or legs depending on the affected area of the spinal cord.
• Loss of Coordination: Difficulty with balance and coordination may occur, leading to an increased risk of falls.

2. Gait Changes:

• Unsteady Gait: Individuals may develop an unsteady walk, characterized by difficulty in balancing or maintaining a straight line while walking.
• Widened Base of Support: Some patients may adopt a wider stance to improve stability when walking.

3. Reflex Changes:

• Increased Reflexes: Hyperreflexia (exaggerated reflex responses) may be noted, particularly in the legs.
• Babinski Sign: An abnormal response to the plantar reflex test (Babinski sign) can occur, where the big toe extends upward instead of flexing downward when the sole of the foot is stroked.

4. Bowel and Bladder Dysfunction:

• Individuals with myelopathy may experience changes in bowel and bladder control, leading to incontinence or retention issues.

5. Pain:

• Radicular Pain: Pain may radiate down the arms or legs, often referred to as “radiculopathy,” depending on which part of the spinal cord is affected.
• Localized Pain: There may also be localized pain or discomfort in the neck (cervical myelopathy) or back (thoracic or lumbar myelopathy).

6. Cognitive or Psychological Changes:

• In some cases, individuals may experience cognitive changes, including confusion or altered mental status, particularly if there is significant pressure on the spinal cord.

Conclusion:

The symptoms of myelopathy can significantly impact an individual’s daily life and functioning. If someone is experiencing any of these symptoms, especially weakness, numbness, or difficulty with coordination, it is important to seek medical evaluation. Diagnosis often includes a thorough clinical history, neurological examination, and imaging studies (such as MRI or CT scans) to determine the underlying cause of myelopathy and guide appropriate treatment. Early intervention is key to preventing further complications and optimizing recovery.

What are the causes of myelopathy?

Myelopathy refers to a neurological condition caused by compression or injury to the spinal cord, which can lead to a variety of symptoms. There are several potential causes of myelopathy, which can be broadly categorized into degenerative, traumatic, infectious, inflammatory, and neoplastic factors. Here are some common causes:

1. Degenerative Conditions:

• Cervical Spondylosis: Age-related wear and tear of the cervical spine can lead to the formation of bone spurs and degeneration of intervertebral discs, causing spinal cord compression.
• Degenerative Disc Disease: Herniation or bulging of discs in the cervical or lumbar spine can put pressure on the spinal cord or nearby nerve roots.
• Spinal Stenosis: Narrowing of the spinal canal, which can occur due to osteoarthritis or congenital factors, may compress the spinal cord.

2. Trauma:

• Spinal Cord Injury: Traumatic events, such as falls, motor vehicle accidents, or sports injuries, can lead to direct damage to the spinal cord and resulting myelopathy.

3. Infections:

• Myelitis: Inflammation of the spinal cord due to infections, including viral (e.g., poliovirus, West Nile virus) or bacterial infections (e.g., tuberculosis), can cause myelopathy.
• Abscesses: Formation of an abscess in or around the spinal cord due to infections can lead to compression and myelopathy.

4. Inflammatory Conditions:

• Multiple Sclerosis (MS): An autoimmune disease that affects the central nervous system, causing demyelination and potential compression of the spinal cord.
• Transverse Myelitis: Inflammation across both sides of one section of the spinal cord can lead to myelopathy due to various causes, including autoimmune diseases or infections.

5. Neoplastic Causes:

• Tumors: Benign or malignant tumors compressing the spinal cord or spinal nerves can cause myelopathy. These tumors can be intrinsic (within the spinal cord) or extrinsic (outside the spinal cord, such as metastases from other cancers).

6. Congenital Conditions:

• Congenital Malformations: Conditions such as Chiari malformation (downward displacement of the cerebellum) or spinal bifida can lead to myelopathy by altering the usual anatomy of the spine and spinal cord.

7. Vascular Causes:

• Vascular Insufficiency: Reduced blood flow or ischemia to the spinal cord due to compromised blood vessels can lead to myelopathy.

8. Other Factors:

• Nutritional Deficiencies: Deficiencies in vitamins (such as vitamin B12) can lead to spinal cord problems, causing myelopathy.
• Toxic Exposure: Certain toxins or heavy metal poisonings can lead to spinal cord injury and resulting myelopathy.

Conclusion:

Myelopathy can arise from many different causes, each requiring a specific diagnostic approach and treatment plan. If someone experiences symptoms of myelopathy—such as weakness, numbness, or coordination problems—it is crucial to seek medical attention for a thorough evaluation to identify the underlying cause and implement appropriate management strategies. Early diagnosis can help prevent further complications and optimize treatment outcomes.

How is the diagnosis of myelopathy made?

The diagnosis of myelopathy involves a thorough evaluation that includes a detailed medical history, neurological examination, and several diagnostic tests to determine the underlying cause of the symptoms. Here’s a step-by-step overview of the diagnostic process for myelopathy:

1. Medical History:

• The healthcare provider will ask about the patient’s symptoms, including when they started, their progression, and any associated factors (such as trauma, previous illnesses, or family history of neurological disorders).
• It’s important to discuss any risk factors that may contribute to myelopathy, such as recent injuries, surgeries, or chronic conditions.

2. Neurological Examination:

• A comprehensive neurological examination will be conducted to assess:
• Motor Function: Evaluation of muscle strength, coordination, and any signs of weakness.
• Sensory Function: Testing for loss of sensation, numbness, or abnormal sensations in the arms and legs.
• Reflexes: Checking for hyperreflexia (exaggerated reflexes), hyporeflexia (diminished reflexes), or changes in deep tendon reflexes.
• Gait and Balance: Assessment of walking stability and coordination.

3. Imaging Studies:

• Magnetic Resonance Imaging (MRI): MRI is the most sensitive test for evaluating the spinal cord. It provides detailed images that can reveal:
• Compression of the spinal cord or nerve roots due to herniated discs, spinal stenosis, or tumors.
• Signs of inflammation or other pathological changes.
• Computed Tomography (CT) Scan: A CT scan may be performed if an MRI is not available or in cases where there is a need to evaluate bony structures in detail.
• X-rays: Plain X-rays can help assess any structural abnormalities in the spine, such as fractures or dislocations.

4. Electrodiagnostic Studies:

• Nerve Conduction Studies (NCS): These tests evaluate the electrical conduction of nerves to assess how well signals travel along the nerves.
• Electromyography (EMG): EMG measures the electrical activity of muscles and can help determine if there is nerve or muscle damage.

5. Lumbar Puncture (Spinal Tap):

• In certain cases, a lumbar puncture may be performed to analyze cerebrospinal fluid (CSF) for signs of infection, inflammation, or other potential causes of myelopathy, such as multiple sclerosis.

6. Other Tests:

• Additional laboratory tests may be ordered to rule out infections, autoimmune disorders, or other systemic conditions that may contribute to myelopathy.

Conclusion:

The diagnosis of myelopathy is made by combining clinical assessment through medical history and neurological examination with advanced imaging and diagnostic studies. The specific underlying cause of myelopathy will guide treatment options, so it is essential to perform a comprehensive evaluation. If individuals experience symptoms suggestive of myelopathy, such as weakness, numbness, or balance difficulties, they should seek medical attention promptly for a thorough evaluation and management. Early diagnosis and treatment are key to optimizing outcomes and preventing further neurological damage.

What is the treatment for myelopathy?

The treatment for myelopathy depends on the underlying cause and severity of the condition, as well as the specific symptoms experienced by the patient. Generally, treatment aims to relieve symptoms, stabilize the condition, prevent further spinal cord damage, and improve overall function. Here’s an overview of the common treatment options:

1. Conservative (Non-Surgical) Treatment:

• Physical Therapy: A structured physical therapy program can help improve strength, coordination, and mobility. Therapists may help develop exercises to enhance balance and functional abilities.
• Pain Management: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or corticosteroids may be used to relieve pain and reduce inflammation.
• Chiropractic Care: Some patients may benefit from chiropractic adjustments and therapies as part of their overall treatment plan.
• Bracing or Orthotic Devices: In some cases, the use of braces or orthotic devices may support stability and improve function, especially for gait or postural issues.

2. Surgical Treatment:

If conservative treatments are ineffective or if there is significant spinal cord compression, surgical intervention may be necessary. Common surgical procedures include:

• Decompression Surgery: This type of surgery aims to relieve pressure on the spinal cord. It may involve:
• Laminotomy or Laminectomy: Removal of a portion of the vertebra (lamina) to create more space for the spinal cord and relieve pressure.
• Discectomy: Removal of a herniated intervertebral disc that is compressing the spinal cord.
• Spinal Fusion: In cases where there is instability of the spine due to degeneration, injury, or deformity, spinal fusion may be performed to stabilize the spine.
• Tumor Resection: If myelopathy is caused by a tumor, surgery may be necessary to remove the tumor, especially if it is compressing the spinal cord.

3. Management of Underlying Conditions:

Treating any underlying conditions contributing to myelopathy is also a key component of care:

• Autoimmune Diseases: Management of conditions like multiple sclerosis may include immunosuppressive medications or disease-modifying therapies.
• Infections: If myelopathy is due to an infection, appropriate antimicrobial therapy will be required.

4. Follow-Up Care:

• Ongoing follow-up with healthcare providers is essential to monitor for any changes or progression of symptoms, adjust treatment plans, and rehabilitate the patient effectively.

Conclusion:

The treatment of myelopathy is individualized based on the specific diagnosis, patient presentation, and overall health. Early diagnosis and intervention can lead to better outcomes, so if someone experiences symptoms associated with myelopathy—such as weakness, numbness, or coordination difficulties—they should seek medical evaluation promptly. A multidisciplinary approach involving neurologists, orthopedic surgeons, physical therapists, and other specialists is often beneficial in effectively managing the condition.