Cervical Myelopathy
How cervical myelopathy appears
Studies have shown that the minimum diameter of the spinal canal in order to avoid pressure on the spinal cord in the neck is 13 millimeters. Anything smaller than this diameter can cause stenosis which may be due to:
- Protrusion or herniation of the intervertebral disc
- Formation of osteophytes (arthritis)
- Hypertrophy of the ligamentum flavum or the articular processes
From the above, a reduced space in the area of the spinal canal results, leading to the loss of the normal lordosis of the cervical spine and the development of kyphosis. Due to the stenosis of the spinal cord, its blood supply is disrupted, and thus cervical myelopathy (damage to the spinal cord itself) occurs.
Cervical Myelopathy
Causes
What are the main causes of cervical myelopathy? The common causes of cervical myelopathy include:
1.
Degenerative spinal conditions such as spinal stenosis
2.
Rheumatoid arthritis
3.
Congenital stenosis
4.
Intervertebral disc herniation
5.
Spondylosis
Cervical Myelopathy
Symptoms
The symptoms of cervical myelopathy initially develop insidiously and gradually, and over a period of many months or years, they reach their peak. They are as follows:
1.
Neck stiffness and diffuse pain in the upper and lower limbs
2.
Numbness and weakness in the upper limbs. The patient is unable to perform tasks requiring fine movements and coordination, such as buttoning a shirt
3.
Spasticity in the legs with disturbances in walking and balance
4.
Disorders of the bowel and bladder
5.
Sexual dysfunction
Cervical Myelopathy
Diagnosis
The orthopedic surgeon will recommend an MRI of the cervical spine, which is considered the most accurate examination for diagnosing the syndrome.
Cervical Myelopathy
Treatment
In cervical myelopathy, the cause that has led to the condition is treated surgically, which is why the doctor must make an accurate diagnosis.
Usually, various surgical techniques are chosen, such as:
1.
Anterior cervical discectomy or corpectomy and spinal fusion (ACDF – ACCF)
2.
Posterior laminectomy and spinal fusion
3.
Combination of the first two methods
4.
Laminoplasty (when spinal fusion is to be avoided)
Laminoplasty
Laminoplasty is a technique that successfully addresses extensive cervical spinal stenosis and cervical myelopathy mainly in younger patients.
With this specific technique, a “door” mechanism is created at the back of the spinal canal and at least 3 laminae are lifted exactly like opening a door. In this way, the spinal canal is widened, giving space for the spinal cord to be reperfused.
It is a smart technique that preserves neck mobility (it is not spinal fusion), offers decompression of the spinal cord, and at the same time allows immediate mobilization of the patient.
Anterior Cervical Discectomy or Corpectomy and Spinal Fusion
When cervical myelopathy is due to localized spondylosis, then the method of corpectomy or anterior discectomy and spinal fusion is chosen. In this surgery, all osteophytes and discs that cause pressure are removed. In some cases, to make this possible, the surgeon proceeds with removal of almost the entire vertebral body in order to reconstruct the spine with special cages and plates that stabilize the construction.
The procedure is done under general anesthesia and with an incision of 3-5 centimeters, using a special surgical microscope. The surgery can last from 1 up to 3 hours depending on the number of discs or vertebrae that need repair. Hospitalization is determined by the surgeon and usually does not exceed 2 days.
Posterior laminectomy and spinal fusion
This method involves accessing the spine from the back and removing all anatomical structures that are compressing the spinal cord in order to indirectly decompress it. Due to the instability caused by the removal of the laminae, simultaneous posterior stabilization (spinal fusion) must also be performed.
