Myelopathy is a condition that describes any neurological deficit or spinal compression that may result from trauma, inflammation, Stenosis, degenerative disease or disc herniation. Let’s get to know more details about myelopathy and treatment options.
In the spinal cord contains a group of nerves that runs almost its entire length. If any portion of the spinal cord gets pressured or constricted, that resulting symptoms are known as myelopathy. It is common among the age group of 50-60 yrs.
Types of myelopathy
Types are divided according to the region of spine involved. They are:
- Cervical myelopathy
- Thoracic myelopathy
- Lumbar myelopathy
- Cervical myelopathy: It is the most common form of myelopathy. Cervical myelopathy occurs in the neck; in this condition, some patients experience neck pain.
- Thoracic myelopathy: It occurs in the middle part of the spine. In this condition, the spinal cord compressed due to some conditions like bone disorders, trauma, herniated etc.
- Lumbar myelopathy: It is a rare condition because the spinal cord ends at the beginning of the lumbar spine.
Causes of myelopathy
It usually occurs as a result of gradual degeneration of the spine. And also due to the aging (arthritis, inflammation), the spinal disc get flattened that exerts pressure on the spinal cord and nerve roots.
Other causes of myelopathy are:
- Autoimmune disorders(rheumatoid arthritis)
- Spinal infection, injuries, inflammation.
- Neurological disorders
- Degenerative spinal conditions like Spinal stenosis
- Herniated disc, hematoma, spinal tumors, bone cancer etc.
Risk factors for myelopathy
There are certain factors that increase you to develop myelopathy are:
- Age (50-60 years)
- Alcohol abuse
- Obesity or overweight
- Lack of physical activity or exercise
- Strenuous exercises or lifting heavy objects
- Participating in intense sports.
If you’re under risk to develop myelopathy consult specialist for preventive measures.
Symptoms of myelopathy
The common symptoms when the spinal cord gets compressed, it usually causes loss of sensation, impaired function, discomfort, and pain.
- Pain in the involved region of the spine
- Loss of urinary and bowel control
- Impaired balance and control
- Difficulty in walking
- Impaired motor skills
- Numbness and tingling sensation
- Increased or abnormal reflexes
Diagnosis of myelopathy
The symptoms are different from person to person according to the region of spine involved. The following are the tests recommended by the doctor to rule out myelopathy.
- Physical examination and complete health history
- An x-ray to evaluate any further involvement
- An MRI scan of the spine
- Myelography or fluoroscopy to reveal abnormalities of the spinal cord
- To study nerve function electrical tests(electromyogram) is performed
If myelopathy caused by a complication of another disease (diabetic myelopathy), in this condition your specialist may refer in terms of disease.
- Carpal tunnel syndrome
- Cervical sprain
- Multiple sclerosis
- Diabetic neuropathy
- Rheumatoid arthritis
Treatment of myelopathy
Usually, the treatment depends on the causes of myelopathy. In the conditions like irreversible, only symptomatic treatment will be given. And the treatment in acute cases includes:
In non-surgical myelopathy, the treatment options include bracing, physiotherapy and anti-inflammatory drugs (NSAIDS).
In mild cases, the treatment is given to minimize pain, and also to make you capable of performing daily activities. This symptomatic treatment does not remove the compression. If your symptoms worsen please consult your physician immediately.
In the non-surgical myelopathy the goals of physical therapy treatment are:
- To relief pain
- To improve function
- To prevent neurological deterioration
- To retain or improve neurological deficits
Physiotherapy techniques may include
- Stretching, to reduce stress on joints
- Exercise, to strengthen muscles
- Water-based exercises, to allow your body to exercise without pressure on the spine
- Limited Physical activity, to promote good physical conditioning
- Heat therapy, to improve blood flow to the muscles and other soft tissues
- Ice therapy or cryotherapy to help relieve pain
- Manual therapy – which includes massage or manipulation of soft tissue and to improve or keep a range of motion
- Educating the patient about improving and maintaining the good posture
- Strengthening exercises of lower limbs that protects from falls
- Pelvic tilts and lower back stabilizing
Based on your normal level of activity physical fitness, and severity of pain, your consultant plans the daily routine.
Myelopathy and its surgical management
Surgical Spinal decompression is a common choice of treatment for myelopathy to relieve pressure on the spinal cord. It is also advised in patients with spinal tumors, herniated discs etc.
In the case of a spinal stenosis to increase the space of your spinal cord Laminoplasty is performed to facilitate flexibility of the spinal cord. In some cases, it is not recommended. Another alternative is to make decompression and spinal fusion (anteriorly or posteriorly).
Brief information about laminoplasty
It is a surgical procedure that is made to relieve abnormal pressure by creating more space for the spinal cord and nerve roots. It is performed under general anesthesia, where the patient lies face down on a surgical bed. A surgical incision is made on the spine. Once the spine is visualized by the surgeon he will cut the lamina carefully. That creates space in the spinal canal.
The Lesser complications and faster recovery are possible in invasive spine surgery when compared to conventional open surgery.
Important instructions must be followed prior to the surgery
- Premedications to be taken exactly prescribed by your physician
- A combination of exercises
- Lifestyle changes
- Oral medications
- Hot and cold treatments
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