What is myelopathy?

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Dr Turaj Yazdi / article / What is myelopathy?
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What is myelopathy?

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The spinal cord is a collection of nerves that extends almost the entire length of the spine. Myelopathy is a type of spinal cord injury that causes pressure on the spinal cord. This pressure can enter the spinal cord due to an accident, congenital spinal stenosis, degenerative disease, or disc protrusion.

Myelopathy

Myelopathy itself consists of several types of syndromes, each of which eventually causes neck pain. like the:

  • Motor System Syndrome
  • Central Cord Syndrome
  • Partial Brown Square Syndrome
  • Transformer Syndrome
  • Mixed radicular and long tube syndrome

In myelopathy, in addition to the vertebrae and the fast joints between them, the ligaments and spinal nerves are also affected and may cause pain.

Source: https://www.hopkinsmedicine.org/

Types of myelopathies

There are several types of myelopathies, depending on where the spinal cord is under pressure:

Cervical Myelopathy

This type of myelopathy occurs in the cervical region of the spine and is the most common type. Neck pain is one of the symptoms of this type of myelopathy but it does not appear in all people.

Thoracic Myelopathy

This type of myelopathy occurs in the middle area of ​​the spine. The spinal cord in these areas is usually compressed for reasons such as: disc swelling, disc protrusion, the formation of bony appendages, or accidents that damage the spine.

Lumbar Thoracic Myelopathy

This type of myelopathy is very rare because in most people, the spinal cord ends before the lumbar spine begins. If a person has a longer spinal cord than usual and has reached the lumbar region, he or she may develop lumbar myopathy.

What causes myelopathy?

Gradual and natural burnout is a common cause of this complication. As you get older, the daily pressure on the spine causes changes in its structure. These changes affect the intervertebral joints, intervertebral discs, and ligaments.

As the intervertebral discs shrink over time, normal distance between the vertebrae reduces. As a result of this process, the articular cartilage between the vertebrae is damaged and the cycle of depreciation continues. Gradual destruction of the discs can also lead to protrusion of the disc, in which case additional pressure is applied to the spinal cord or nerve roots. On the other hand, due to the pressure and gradual destruction of the discs, bony appendages are formed in the vertebrae, which narrow the spinal canal and put pressure on the spinal cord.

Injuries due to accidents, sports activities and … are other causes of myelopathy. In addition to affecting the muscles and ligaments that balance the spine, these injuries can also lead to bone fractures or joint dislocations. Such injuries are a common cause of Central Cord Syndrome.

Autoimmune disorders can also lead to myelopathy, such as rheumatism, which affects the joints of the spine and especially the upper neck. Tumors, infections, or congenital malformations are rare causes of myelopathy.

What are the symptoms of myelopathy?

Generally, when the spinal cord is pressurized or damaged, the injury causes loss of sensation, function, and pain in the same area under pressure or around it.

Common symptoms of myelopathy include stiff neck, a deep pain in one or both sides of the neck, and possibly in the arms and shoulders, stiffness and weakness in the legs, results in difficulty walking, and a ringing in the neck when moving. People with this condition usually have sudden, tingling pain in the arms, elbows, and wrists, or they may experience mild pain and numbness.

More precisely, the symptoms of myelopathy can vary depending on where it occurs. In cervical myelopathy, for example, these symptoms are more common in the neck and arms

How is myelopathy diagnosed?

Myelopathy does not have unique symptoms, so accurate diagnosis is important. The first step in diagnosing myelopathy is to perform a physical examination and prepare a medical history. Your doctor will check your body for reflux to see if the reflux has increased (so-called hyperreflexia). It also examines muscle weakness and numbness (especially in the arms and palms) and muscle atrophy in which the muscles gradually shrink and disappear.

If the results of your physical exam and medical history convince your doctor that you may have myelopathy, you will be given more diagnostic tests, such as: X-rays to check the orientation of the cervical vertebrae, MRI to check. Myelography tests are usually prescribed for patients who cannot have an MRI test. An electromyographic (EMG) test can also be helpful in diagnosing other disorders that may have symptoms similar to myelopathy.

Your doctor will sometimes put myelopathy at the end of the main complication and tell you the diagnosis. For example, you may be told that you have cervical stenosis with myelopathy or that you have a thoracic disc disorder with myelopathy.

Source: https://www.bonati.com/

What are the ways to treat myelopathy?

The treatment of myelopathy is chosen depending on the causes. And although in some cases, the symptoms are not treatable, but by choosing the appropriate treatment method, the further progression of the complication can be prevented and its symptoms can be alleviated.

Non-surgical treatment

Although surgery is the best way to treat myelopathy to reduce the pressure on the spinal cord, the passage of time with informed care can also be a good way to improve the condition in cases where the patient has mild symptoms. If your myelopathy symptoms are mild, your doctor may:

Suggest you use a medical necklace to hold the vertebrae in your neck

To improve the strength and flexibility of the neck, teach you a few exercises

To reduce pain, prescribe massage of muscles and bones, or take painkillers

Non-surgical treatments do not relieve the pressure on the spinal cord, so your disease may progress. if you notice that your symptoms are getting worse day by day, tell your doctor as soon as possible.

Some experts do not recommend non-surgical treatments for myelopathy. Because it has been shown that some of these methods may not only not help treatment but may even cause neurological problems and disorders.

Epidural Steroid Injection (ESI) – Steroid Injection (ESI)

Injecting steroids into the epidural area of ​​the spine, in addition to relieving pain caused by muscle strain or sprain, can also reduce inflammation. Steroid injection is a combination of cortisone (a strong and anti-inflammatory steroid) and local anesthesia that is injected through the back into the epidural space of the spine. Note that this injection is not always effective in relieving the inflammation, and injections may be recommended only when other non-surgical methods do not work.

Surgical treatment

The main purpose of surgery to treat myelopathy is to relieve the pressure on the spinal cord. Your doctor may choose the method of posterior laminotomy (surgery to make the necessary incisions in the lumbar region – laminotomy). A method in which the distance between the vertebrae that put pressure on the spinal cord is increased to create enough space for the spinal cord, without being under pressure. However, this method is not suitable for all patients because it may cause kyphosis (forward thoracic spine arch) or instability in parts of the spine. Another method that your doctor may choose is the anterior cervical method (surgery by making the necessary incisions in the front of the neck – Anterior Cervical Approach). A method that enables the doctor to have a direct view of the vertebrae and remove bone appendages or intervertebral discs that may put pressure on the spinal cord. This surgery may also involve spinal fusion (joining the vertebrae together to stabilize the spine) to prevent possible postoperative problems.

DR.TURAJ YAZDI

SPINE SURGEON
The best way for disc surgery and it’s fundamentals
⭐Turaj Yazdi M. D.⭐

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