Myeloradiculopathy is a condition where both the spinal cord (“myelo-“) and the nerve roots (“radiculo-“) are compressed or damaged. The suffix “-pathy” signifies a disease or disorder. This dual involvement leads to a combination of symptoms affecting various bodily functions.
Underlying Causes of Myeloradiculopathy
Myeloradiculopathy frequently arises from degenerative changes within the spinal column, which can simultaneously compress the spinal cord and nerve roots. Spinal stenosis, a common cause, involves the narrowing of the spinal canal, the bony tunnel enclosing these neural structures. This narrowing can occur in the central canal or where nerve roots exit the spine, leading to pressure.
Herniated or bulging discs also contribute significantly to this condition. Intervertebral discs act as cushions between vertebrae. When the outer layer weakens or tears, the inner material can protrude or leak out, pressing directly on the spinal cord or nearby nerve roots. This compression can result from sudden injury or gradual wear and tear.
Degenerative disc disease involves the gradual deterioration of these intervertebral discs. As discs deteriorate, the space between vertebrae can shrink, leading to instability. This degeneration often promotes the formation of bone spurs, known as osteophytes, which are bony growths that develop around the facet joints and discs. These osteophytes can extend into the spinal canal or neural foramina, further constricting space and compressing the spinal cord and nerve roots.
Less common causes of myeloradiculopathy include spinal trauma, such as fractures or dislocations, which can directly injure or compress neural tissues. Tumors growing within or near the spinal canal can exert pressure as they expand. Severe infections, like epidural abscesses or discitis, can also lead to inflammation and swelling that compress these structures.
Recognizing the Combination of Symptoms
Myeloradiculopathy manifests through a unique blend of symptoms, reflecting both spinal cord and nerve root compression. Symptoms stemming from spinal cord compression are referred to as myelopathy. These often involve difficulties with balance and coordination, such as an unsteady or clumsy gait. Individuals may also experience a decline in fine motor skills, making tasks like buttoning a shirt, writing, or picking up small objects challenging.
Myelopathy symptoms can also include widespread numbness or weakness in the limbs, often affecting both sides of the body. Patients might report clumsiness in their hands or feet, or a loss of sensation that makes it difficult to perceive temperature changes. In more advanced cases, bladder or bowel dysfunction, such as urinary urgency or retention, may develop.
Conversely, symptoms arising from nerve root compression are termed radiculopathy. These typically present as sharp, shooting pain, numbness, or tingling that radiates along a specific nerve pathway. A common example is sciatica, where pain travels from the lower back down the leg. Similarly, cervical radiculopathy can cause pain, numbness, or weakness to radiate down an arm into the hand.
A person with myeloradiculopathy experiences both types of symptoms simultaneously. For instance, someone might have neck stiffness and unsteadiness when walking due to spinal cord involvement, alongside shooting pain and tingling down one arm from a compressed nerve root. The combined presentation of these myelopathic and radiculopathic signs helps distinguish this condition from isolated nerve or spinal cord issues.
The Diagnostic Process
Diagnosing myeloradiculopathy involves a thorough evaluation to pinpoint the location and cause of spinal cord and nerve root compression. The initial step typically includes a comprehensive physical and neurological exam. During this assessment, a healthcare provider tests reflexes, muscle strength, sensation, gait, and coordination.
Imaging studies are paramount for confirming the diagnosis and visualizing the spinal structures. Magnetic Resonance Imaging (MRI) is the most informative tool, providing detailed images of soft tissues like the spinal cord, discs, and ligaments, clearly showing disc herniations, spinal stenosis, bone spurs, and any resulting compression. While MRI is preferred, Computed Tomography (CT) scans or CT myelograms may be used as alternatives, especially if MRI is contraindicated or for more detailed bony visualization. A CT myelogram involves injecting a contrast dye into the spinal fluid before the CT scan, which helps highlight the spinal canal and nerve roots.
Nerve function tests provide additional insights into the extent of nerve damage. Electromyography (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve Conduction Studies (NCS) assess how well electrical signals travel along nerves. These tests can confirm nerve root damage, distinguish it from other conditions and help locate the specific site of nerve compression, complementing imaging information.
Available Treatment Approaches
Treatment for myeloradiculopathy aims to relieve pressure on the spinal cord and nerve roots, reduce symptoms, and improve function.
Initial management often involves non-surgical approaches, particularly for mild to moderate symptoms. Physical therapy plays a significant role, focusing on exercises to improve posture, strengthen supporting muscles, and enhance flexibility. Occupational therapy can also assist by teaching adaptive strategies for daily tasks to minimize strain.
Medications are frequently prescribed to manage pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce swelling around the affected nerves. For more severe nerve pain, specific nerve pain medications might be used. Epidural steroid injections, delivered directly into the space around the spinal cord and nerve roots, can provide temporary relief by reducing localized inflammation.
Surgical intervention is typically considered when conservative treatments do not provide adequate relief, or if neurological symptoms are severe, progressive, or indicate significant spinal cord compression. The primary goal of surgery is decompression, meaning the removal of the structures that are pressing on the spinal cord and nerve roots. Common surgical procedures include laminectomy, where a portion of the bony arch (lamina) of a vertebra is removed to create more space. A discectomy involves removing a herniated disc fragment that is compressing nerves.
In some cases, spinal fusion may be performed concurrently with decompression. This procedure involves permanently joining two or more vertebrae to stabilize the spinal segment after the removal of disc material or bone. Fusion can help prevent further instability and may be recommended when significant structural changes are present or when multiple levels of the spine require decompression. The specific surgical approach, whether from the front (anterior) or back (posterior) of the spine, depends on the location of the compression and the surgeon’s assessment.