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Cervical myelopathy refers to compression of the spinal cord in the neck or upper back. The condition is commonly tied to age-related degeneration of discs and facet joints, causing narrowing of the spinal canal and cord dysfunction. Herniated discs may also contribute to cervical myelopathy, impinging the cord as it passes through the narrow canal. Although it is rarely painful, the condition is progressive, causing various symptoms.
Causes of Cervical Myelopathy
Cervical myelopathy occurs when the long tracts of the spinal cord are compressed passing through the cervical spinal canal. Stenosis, or narrowing of the spine’s bone passage, reduces the spinal cord’s clearance through the canal, commonly resulting in myelopathy symptoms. The progressive condition typically develops slowly, as a result of degenerative changes to the cervical spinal structure. However, the onset of symptoms may be accelerated due to acute trauma or sports injury. The pathological processes responsible for cervical myelopathy include the following causes:
- Spondylosis – Cervical spondylotic myelopathy develops with age, resulting from disc degeneration and arthrosis of facet joints. Over time, this form of osteoarthritis diminishes the diameter of the cervical spinal canal, causing cord compression. CSM is so common among the elderly; radiological studies show signs of spondylosis in a majority of patients over age 70. Many rheumatoid arthritis patients with cervical involvement experience myelopathy.
- Congenital Factors – Some people are born with naturally narrow spinal canals. The congenital condition doesn’t usually manifest symptoms, until further stenosis occurs later in life.
- Herniated Disc – In addition to progressive disc disease associated with spondylotic myelopathy symptoms, acute disc herniation can also contribute to cervical compression.
- Trauma – Acute trauma can precipitate cervical myelopathy symptoms, particularly among those with canals of narrow diameter.
- Ossification – Thought to affect about 25% of patients diagnosed with cervical myelopathy, ossification, or formation of bone on vertebral bodies, can impinge the spinal cord, causing myelopathy.
Description of Cervical Myelopathy
The diameter of the spinal cord averages approximately 10mm in the neck. Clearance is adequate in a normal spinal canal, measuring 17mm-18mm, but as degeneration and other causes narrow the passage to 12mm-14mm, cervical myelopathy and related symptoms are likely to develop.
Among the most common spinal complaints of patients over 50, age-related risk factors for cervical myelopathy include bone spurs, thickened ligaments, and bulging discs. Although the condition is more prevalent among the elderly, damage to the sensitive fibers of the spinal cord can also result from acute trauma or injury, prompting mid-life symptoms.
Symptoms of Cervical Myelopathy
Depending upon the exact cause and severity of each condition, cervical myelopathy may present the following symptoms:
- Poor coordination and/or balance, clumsiness
- Heaviness in the legs
- Tingling in the extremities
- Problems with fine motor control – writing, etc.
- Arm and leg weakness
- Pain is reported in many cases, but isn’t always present
- Urgent need to urinate
- Leg stiffness with rigid gait
- Decreased dexterity
- Poor exercise tolerance
Cervical Spondylosis (Arthritis of the Neck)
Cervical spondylosis, or osteoarthritis of the neck, is a common age-related condition, impacting millions. Although many people who have it experience no symptoms, the condition typically worsens with age, sometimes causing pain, stiffness and other indications. The chronic disorder cannot be cured, but effective intervention enables those with neck arthritis to live normal daily lives.
Cause of Cervical Spondylosis
Cartilage and bones are subject to wear, so degenerative conditions like cervical spondylosis develop after years of use. It is thought more than 80% of those over age 60 may exhibit signs of the condition -most without symptoms. Although aging is the greatest risk factor for cervical spondylosis, other elements may contribute to this type of neck pain. Athletic injury, for instance, can accelerate the aging process, leading to neck arthritis. And repetitive, strenuous activities, such as those conducted on-the-job, may also irritate associated muscles, ligaments, and nerves, increasing risk for cervical spondylosis.
Description of Cervical Spondylosis
This type of osteoarthritis occurs when aging cervical discs change, reducing their ability to cushion vertebrae in the neck. The discs, comprised of fibrous outer layers surrounding gel-like cores, serve as shock-absorbers, facilitating flexibility and range of motion in the neck. Some disc degeneration is expected, as a normal part of aging, but as these changes take place; some older adults develop pain and stiffness. In many cases, rough, boney patches called osteophytes develop on the edges of neck vertebrae, contributing to cervical spondylosis. And as cervical discs naturally grow less hydrated, the risk for cervical spondylosis also increases.
Symptoms of Cervical Spondylosis
Common symptoms of cervical spondylosis include the following:
- Neck pain and stiffness, which may worsen with activity
- Numbness and weakness in arms, hands and fingers
- Trouble walking, loss of balance or weakness in hands or legs
- Muscle spasms in neck and shoulders
- Grinding and popping sound/feeling in neck with movement
- Pain may worsen when looking up or down for a long time, or with certain activities
- Pain may improve with rest or lying down
Cervical Radiculopathy (Pinched Nerve)
Cervical radiculopathy is more commonly referred to as a ‘pinched nerve’. The condition is characterized by pain radiating from the neck into the upper back, chest, shoulders and arm of the individual. It can also be accompanied by a general weakness, tingling, or numbness in the affected arm or hand. Cervical radiculopathy most often affects adults, particularly people over the age of 50 and those suffering from arthritis in the cervical (neck) region. However, the condition can also be found in younger and more active individuals such as athletes and heavy laborers.
Causes of Cervical Radiculopathy
Cervical radiculopathy occurs when a nerve root in the cervical spine becomes irritated, either through compression or inflammation. This then forces pain signals to radiate along the nerve’s pathway into the upper back, shoulders and arms of the affected individual. Cervical radiculopathy is caused by a number of factors – some age related, while others may be the result of specific trauma or physical stress.
In older adults the natural degeneration of cervical discs can lead to pressure on nerve roots as they exit the cervical spine. This is one of the more common causes of cervical radiculopathy in people over the age of 50. Arthritis can also be a factor, causing inflammation and irritation of nerve roots, resulting in pain associated with the condition.
Cervical radiculopathy in younger people is more often caused by physical trauma or repetitive stress, resulting in a herniated disc. This places pressure on a nerve root, causing pain to radiate out to the affected areas. Trauma or stress induced cervical radiculopathy is most commonly experienced by athletes, heavy laborers, and people operating heavily vibrating machinery.
Symptoms of Cervical Radiculopathy
The most common symptoms associated with cervical radiculopathy include:
- Neck pain radiates into shoulder and arm
- “Sharp” pain travels down arm
- Numbness or “pins and needles” sensation in arm
- Feeling of weakness with certain activities
- Extending or straining neck or turning head increases pain
- Some pain relief when hand placed and head and shoulder stretched