What is Myelopathy?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

A spinal cord is a group of nerves inside the spine that extends the length of a person’s spine. When any area of the spinal cord becomes constricted or compressed, a medical condition called myelopathy may develop. Myelopathy, an injury to the spinal cord, may develop because of trauma or another medical condition. The medical conditions vary from a herniated disc, congenital stenosis or degenerative disease.

Myelopathy is often confused with myopathy and radiculopathy. They are not the same. Myopathy is a medical condition that causes damage to a person’s muscles. Radiculopathy is a medical condition which does affect the nerve. However, it occurs at the root of the nerve that exits the spinal cord or crosses the intervertebral disc. It’s known as a pinched nerve.

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More About Myelopathy

lumbar foraminotomyMyelopathy is a condition of the spinal cord that is caused by abnormal pressure placed on it. The condition doesn’t place pressure on the root of the nerve like radiculopathy. Since there is abnormal pressure placed on the spinal cord, a person may experience loss of nerve function where the damage occurred. This type of medical condition typically causes pain for individuals more than 55 years old.

Before we discussed symptoms such as back pain and myelopathy treatment, it’s important to provide a more detailed description of the condition. Myelopathy may develop in any area of a person’s spine. The location determines the name of the type of myelopathy condition.

For example, cervical myelopathy is the most common type of myelopathy. It develops in the neck. Lumbar myelopathy is a rare form of the condition. It develops in the top of a person’s spinal cord and ends at the top are of their lumbar spine. When their spinal cord is tethered or low, lumbar myelopathy can occur. Thoracic myelopathy is another type of myelopathy. It develops in the middle of a person’s spine. Their spinal cord becomes compressed in that area because of a herniated disc.

The pressure in the spinal cord causes a loss of space available for the cords located in the spinal cold. The damage can range from mild to extremely severe. Myelopathy can cause an individual to have trouble with various activities like walking down stairs. The symptoms of myelopathy occur slowly. A person may not know they have the medical condition until the pressure in their spinal cord has become at least 30 percent compressed. 

What are the Symptoms?

When a person’s spinal cord is injured or compressed, they may develop many symptoms.

Common Symptoms Include:

  • Loss of sensation: Can cause numbness, tingling or weakness in the arms and legs.
  • Pain: A person may experience back pain. They may also experience pain in their legs, arms and neck.
  • Inability to Control Body: For example, when a person flicks their middle finger, it causes their index finger and thumb to flex.
  • Reflex Increase: This means a person notices their arms and/or legs develop an abnormal reflex.

Myelopathy symptoms can cause havoc on a person’s body that doesn’t involve their arms and legs. . The condition may affect a person’s ability to control their bowel movements. It may also cause a loss of urinary control. They may have problems walking because their balance and coordination is changed because of the pressure on their spinal cord.

How is Myelopathy Diagnosed?

  • Medial History: The first step in a myelopathy diagnosis is for a doctor to obtain a person’s medical history. A medical history is done to find out any symptoms the person is currently experiencing. In addition, the doctor wants to know if there is any history of the medical condition in the person’s family. The next step is for the person to undergo a physical examination.
  • Symptom Assessment: Myelopathy symptoms are not specific to just this medical condition. This means that a person can have many of the same symptoms described above, but have a different medical condition. Thus, a doctor may recommend a person under some medical tests to determine if they have myelopathy or another medical condition.
  • Diagnostic Imaging: An X-ray is performed on the individual to exclude other medical issues. A magnetic resonance imaging (MRI) scan is also done. The doctor uses the scan to have a better look at the person’s spinal canal and spine. Electrical tests such as somatosensory or an electromyogram may be performed to determine how a person’s nerves are functioning.

What are the Causes of Myelopathy?

low back pain

  • Age-Related Wear and Tear: As a person grows older, their bones change. For instance, bits of bone may break of causing bone spurs.
  • Inflammation: Can cause pressure on the cords in the spine.
  • Present at Birth: Myelopathy develops over time, but it can also be present at birth. If the medical condition is present at birth, it is usually because of a deformity in the spine.
  • Other Disorders: Auto-immune disorders like rheumatoid arthritis can affect the spine. Any spinal tumors, hernias, hematomas and cysts may also cause myelopathy.

How is Myelopathy Treated?

Treatment and procedure options for Myelopathy range from conservative options like injections to more intensive procedures like spinal fusions.

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Myelopathy

The equipment used to diagnosis and treat myelopathy depends on what a doctor orders. For example, MRI scan and X-rays are commonly used to look at the spinal cord and rule out any other diseases or medical conditions. Myelography may also be used. It uses contrast material. A myelography is used in conjunction with a real-time X-ray called a fluoroscopy. Together they may reveal abnormalities in a person’s spinal cord to assist in determining myelopathy.

Equipment used in the treatment varies. Back and neck braces are examples of equipment used to decrease myelography symptoms. Surgical procedures may use equipment to decrease the pressure on a person’s spine.

How Does Myelopathy Compare to Other Spine Conditions?

Myelopathy is associated to many other types of disease and medical conditions. It can worsen existing diseases such as diabetes. It can be treated to relieve symptoms such neck pain. Medical conditions such as a herniated disc may make myelopathy symptoms worse than similar conditions like myopathy. It may occur gradually with and/or without treatment. Also, the medical condition can cause more severe pain because a person may experience loss of function compared to other conditions that damage the roots of the nerve.

Myelopathy may cause more trouble that similar conditions for a person who has the condition. They may suffer from a stiff neck and weakened muscles. It’s not uncommon for a person with myelopathy to have issues with maintaining their balance while walking and/or standing.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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