Myelopathy is a neurological disorder resulting from the compression of the spinal cord. This compression restricts the cord’s ability to transmit signals between the brain and the rest of the body, leading to symptoms that affect motor function, sensation, and coordination. Understanding the nature of the spinal cord injury and the goals of intervention is the first step in exploring the prognosis and potential for recovery.
What Myelopathy Is and Why It Occurs
Myelopathy occurs when the spinal cord itself is squeezed or constricted, which is distinct from nerve root compression that causes radiculopathy. This pressure can happen in the cervical (neck), thoracic (mid-back), or lumbar (lower back) spine, with cervical myelopathy being the most common form.
The primary reason for this narrowing is age-related degenerative changes in the spine, often referred to as spondylosis. Common contributing factors include spinal stenosis, disc herniation, the formation of bone spurs (osteophytes), and the thickening of spinal ligaments due to arthritis. While degeneration is the most frequent cause, myelopathy can also result from spinal trauma, tumors, infections, or congenital spine deformities.
Defining Cure and Treatment Goals
When considering a “cure” for myelopathy, it is important to distinguish between reversing the injury and halting its progression. A true cure—meaning the complete reversal of all neurological damage and symptoms—is not always possible, especially if the compression has been long-standing. The spinal cord has limited capacity to regenerate damaged nerve tissue, meaning some deficits may be permanent.
The foremost goal of any myelopathy treatment is to arrest the progression of the condition and prevent further neurological deterioration. Secondary goals include achieving the maximum possible recovery of function and alleviating existing symptoms. The potential for a patient to regain lost function depends significantly on the duration and severity of the compression before intervention.
Conservative Management Options
Conservative management, which involves non-surgical interventions, is generally reserved for patients with very mild, non-progressive myelopathy or when surgical risk is too high. These approaches focus on managing symptoms rather than physically relieving the spinal cord compression.
Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers are commonly used to manage pain and reduce inflammation. Physical therapy can help maintain muscle strength, flexibility, and range of motion, which supports overall function. Bracing or cervical collars may be used to limit spinal movement and provide temporary pain relief. However, these methods only address the symptoms and cannot decompress the spinal cord.
Surgical Intervention Methods
Surgery is often considered the definitive treatment for myelopathy because it is the only way to physically remove the source of spinal cord compression. The primary surgical goal is decompression, which involves creating more space for the spinal cord, often followed by stabilization of the spine with fusion. The choice of surgical approach—anterior (from the front) or posterior (from the back)—depends on the location of the compression and the number of spinal levels involved.
Anterior Approach
The anterior approach is commonly used when the compression is primarily coming from the front of the spinal cord, such as from a herniated disc or a bone spur. Procedures like Anterior Cervical Discectomy and Fusion (ACDF) involve removing the disc and fusing the vertebrae together to maintain stability. A corpectomy is a more extensive anterior procedure where a vertebral body is removed to decompress the cord over multiple levels.
Posterior Approach
The posterior approach is typically preferred for compression affecting multiple levels or when the pressure is coming from the back, often due to thickened ligaments. Laminectomy involves removing the lamina, the back part of the vertebra, to create more space. Laminoplasty is an alternative that involves reshaping the lamina into a “door” that is hinged open and held in place with small plates, which effectively widens the spinal canal. Both anterior and posterior surgeries have demonstrated similar efficacy in improving patient outcomes, with the best choice being highly individualized based on the specific pathology.
Post-Treatment Rehabilitation and Expectations
Recovery from myelopathy treatment, especially surgery, is a gradual process that extends over several months. The most rapid and noticeable improvements in function typically occur within the first three to six months following decompression. Patients can continue to experience improvement for up to a year or more after the procedure.
Physical therapy (PT) and occupational therapy (OT) are integral to the recovery phase, helping patients regain strength, balance, and fine motor skills lost due to the compression. Early engagement in post-surgical rehabilitation, ideally within six weeks, is associated with superior outcomes. Patients should have realistic expectations, as some neurological deficits, such as persistent numbness or weakness, may remain even after successful decompression. Follow-up care is necessary to monitor for any recurrence of symptoms or the development of adjacent segment disease.