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Cervical Myelopathy

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Introduction

Cervical Myelopathy involves spinal cord compression and ischemia (lack of blood flow) to the spinal cord. This occurs at the neck, otherwise known as the cervical spine. It is considered an urgent condition as it can cause permanent damage and progressively worsening symptoms, and as such, requires prompt and accurate assessment. If you are experiencing these symptoms, seek medical advice with urgency.

Symptoms

  • Pain in the neck, and/or upper and/or lower limbs.
  • Numbness/altered sensation/weakness in the limbs.
  • Reduced coordination/dexterity (clumsiness).
  • Poor balance/dizziness/falls.
  • Headaches.
  • Altered gait (walking) pattern.
  • Altered bladder/bowel function.

 

Patients generally report the symptoms have been coming on over months, and gradually worsening.

Causes

Cervical myelopathy typically arises due to degenerative changes in the neck which can occur in the intervertebral discs, ligaments, or bones. This can also occur via trauma.

Prevalence

The prevalence of Cervical Myelopathy increases with age. It is rare to experience this prior to 40, and patients are mostly first diagnosed between 50-60 years of age.

Assessment & Diagnosis

Your Physiotherapist will carry out a clinical examination for an accurate working diagnosis to be formed. If a myelopathy is expected, an MRI (Magnetic resonance imaging) scan will be required. If this diagnosis is confirmed, a spinal Orthopaedic opinion is then required to determine whether decompression surgery is appropriate, and with what degree of urgency. This will be based on the extent and site of compression, which symptoms are present and crucially, whether the symptoms are deteriorating as well as the potential risk it could worsen if left untreated. The rate of symptom progression can vary a great deal but it is important that this is investigated thoroughly as delayed treatment can result in poorer outcomes.

Physiotherapy

Surgery is not always the course of action. People with Myelopathy can have symptoms which are particularly mild & worsen very slowly with time, if at all. They may benefit from regular review, and Physiotherapy/medication rather than surgical intervention. Frequent re-assessment will check that you are making suitable progress and means that adjustments in your rehabilitation plan can be made.

 

If surgery is required, Physiotherapy can be beneficial post-operatively. This can include working on strength, balance and coordination with a personalised and progressive rehabilitation plan.

Additional Resources

Click here to find out more information on this condition from The British Medical Journal

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