Cervical Myelopathy (Spinal Cord Compression)
Cervical myelopathy is different from the other conditions on this site. It is compression of the spinal cord itself, not a single nerve, and it tends to progress in steps rather than improve on its own. That is why it is one of the few spine conditions where surgery is often recommended earlier rather than later.
Recognizing myelopathy
Symptoms often creep in and are easy to blame on age. Common early signs are difficulty with fine hand tasks such as buttoning a shirt or writing, numbness in the hands, dropping objects, a feeling of unsteadiness when walking, and stiffness or heaviness in the legs. Some patients notice an electric sensation down the spine when bending the neck forward. Neck pain may be mild or absent, which is part of why it is missed.
On examination, the surgeon looks for signs of spinal cord involvement such as brisk reflexes, abnormal reflexes in the hands and feet, and changes in gait. An MRI of the cervical spine confirms the diagnosis and shows the degree of compression and any signal change within the cord.
Why timing matters
Unlike a pinched nerve root, a compressed spinal cord does not reliably recover once it has been damaged. Myelopathy typically follows a stepwise course: periods of stability interrupted by declines, sometimes triggered by a minor fall or neck injury. The purpose of surgery is to remove the compression to halt that progression and give the cord the best chance to recover what it can. Patients operated on earlier, with milder deficits, tend to do better than those who wait until function is significantly lost.
Mild myelopathy with stable symptoms can sometimes be observed closely, but this is a decision to make with a spine surgeon, not by default.
Surgical options
The operation is chosen by where and how the cord is compressed. Compression at one or two levels from the front is often treated with an anterior cervical discectomy and fusion (ACDF) or, when a vertebral body must be removed, a corpectomy and fusion. Compression across several levels, particularly from behind, may be treated through the back of the neck with a laminoplasty, which hinges the bone open to enlarge the canal while preserving motion, or a laminectomy with fusion. Some patients need a combined approach. Dr. Michael's fellowship training at Twin Cities Spine Center included complex cervical reconstruction, and he reviews each option, including its recovery and trade-offs, before recommending one.
Common questions
Will my hands and balance recover after surgery?
The most reliable result of surgery is stopping further decline. Many patients also regain some function, especially when surgery is done before deficits become severe, but recovery of the spinal cord is variable and cannot be promised.
Is cervical myelopathy an emergency?
Usually not an emergency, but it is time-sensitive. Rapidly worsening weakness, new bladder or bowel changes, or a fall with new symptoms should be evaluated urgently.
Can physical therapy or injections treat myelopathy?
They do not relieve pressure on the spinal cord. Therapy can help with balance and strength, but it does not replace decompression when the cord is significantly compressed.