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Myelopathy: Causes, Symptoms and Treatment

Myelopathy refers to damage or dysfunction of the spinal cord, affecting movement, sensation and organ control. Early diagnosis and treatment are essential for recovery.

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Things worth knowing about "Myelopathy"

Myelopathy refers to damage or dysfunction of the spinal cord, affecting movement, sensation and organ control. Early diagnosis and treatment are essential for recovery.

What is Myelopathy?

Myelopathy is a broad medical term describing any disease or injury that causes dysfunction of the spinal cord (medulla spinalis). The spinal cord is a critical part of the central nervous system, responsible for transmitting signals between the brain and the rest of the body. Damage to the spinal cord can lead to significant impairments in motor function, sensation, and autonomic (involuntary) control. Myelopathy is not a single disease but rather an umbrella term covering a range of causes and clinical presentations.

Causes

Myelopathy can result from a variety of underlying conditions, including:

Degenerative: Age-related wear and tear of the spine, such as cervical spondylosis or herniated discs, compressing the spinal cord (compressive myelopathy).
Vascular: Reduced blood supply to the spinal cord due to infarction or arteriovenous malformations.
Inflammatory / autoimmune: Conditions such as multiple sclerosis or neuromyelitis optica spectrum disorder (NMOSD).
Infectious: Viral infections (e.g., HIV, HTLV-1), bacterial infections, or parasitic diseases.
Tumors: Primary spinal cord tumors or metastases compressing the cord.
Traumatic: Spinal injuries resulting from accidents or falls.
Metabolic: Vitamin B12 deficiency (subacute combined degeneration), copper deficiency, or toxic damage.
Radiation-induced: Radiation therapy targeting the spine or nearby areas may damage spinal cord tissue.

Symptoms

Symptoms of myelopathy vary depending on the location and extent of spinal cord involvement. Common signs include:

Motor disturbances: Muscle weakness, spasticity (muscle stiffness), gait disturbances, and in severe cases, paralysis.
Sensory disturbances: Numbness, tingling, burning sensations, or reduced perception of touch, pain, or temperature.
Coordination problems: Unsteady gait and balance difficulties.
Bladder and bowel dysfunction: Urinary incontinence, urinary retention, or bowel incontinence.
Sexual dysfunction: Impairment of sexual function due to disrupted nerve signals.
Pain: Local spinal pain or pain radiating into the arms or legs.

Symptoms may develop gradually over weeks to months (chronic myelopathy) or appear suddenly (acute myelopathy), depending on the underlying cause.

Diagnosis

Diagnosing myelopathy requires a combination of clinical assessment and diagnostic investigations:

Neurological examination: Assessment of reflexes, muscle strength, sensation, and coordination.
MRI of the spine: Magnetic resonance imaging is the primary imaging method to visualize the spinal cord and surrounding structures.
CT scan: Used to assess bony abnormalities such as stenosis or fractures.
Lumbar puncture (spinal tap): Analysis of cerebrospinal fluid for signs of inflammation, infection, or malignancy.
Electrophysiology: Evoked potentials (somatosensory and motor) to assess spinal cord conduction.
Blood tests: Measurement of vitamin B12, copper, inflammatory markers, autoantibodies, and infection serology.

Treatment

Treatment of myelopathy is directed at the underlying cause and aims to prevent further damage to the spinal cord while maximizing functional recovery.

Conservative Treatment

For mild compressive myelopathy: physiotherapy, pain management, and activity modification.
For inflammatory causes: corticosteroids, immunosuppressants, or biologic agents.
For vitamin B12 deficiency: supplementation via injections or high-dose oral preparations.
For infectious causes: targeted antiviral or antibiotic therapy.

Surgical Treatment

In cases of compressive myelopathy caused by herniated discs, spinal stenosis, or tumors, surgical decompression of the spinal canal may be required. Early surgical intervention significantly improves prognosis and the chance of neurological recovery.

Rehabilitation

Neurological rehabilitation is a key component of myelopathy management. Physical therapy, occupational therapy, speech therapy, and neuropsychological support help patients regain independence and improve their quality of daily life.

Prognosis

The prognosis of myelopathy depends largely on the underlying cause, the severity of spinal cord damage, and how quickly treatment is initiated. With early intervention, partial or even full recovery is possible in some cases. Chronic or degenerative forms typically require long-term monitoring and lifestyle adaptation.

References

Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine. 2015;40(12):E675-E693.
Kalb S, Martirosyan NL, Kavyani MF, Beier AD, Dean B, Theodore N. Genetics of the Degenerative Cervical Spine. World Neurosurgery. 2012;77(3-4):531-543.
Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Wang JC. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy. Global Spine Journal. 2017;7(3 Suppl):1S-4S.

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