Myelopathy is a clinical syndrome describes any neurological deficit related to the spinal cord compression or malfunction, caused by degenerative, arthritic changes of the spine, trauma, inflammatory process, or vascular incidents that are causing damage of the spinal cord substances and lead to myelopathic features. Pre-existing spinal canal stenosis is a major risk factor for cervical spinal myelopathy after trauma.
Clinical
Features and presentation of Myelopathy:
Clinical signs and symptoms depend on which
part of the spinal cord level (cervical, thoracic, or upper lumbar) is affected
and the extent (anterior, posterior, or lateral) of the pathology. In addition,
the progression rate of the disease (acute like trauma and vascular incident,
sub-acute like disc herniation, or chronic like CSM).
Clinically, patient will presented with
signs and symptoms of upper motor neuron disease—weakness, spasticity,
clumsiness, increase tone, hyperreflexia, bowel/bladder symptoms, sexual
dysfunction, pathological reflexes, including Hoffmann’s sign and inverted
plantar reflex (positive Babinski sign) and different patterns of sensory
changes. Clinical features are usually affecting the area of the body at/below
the level of the spinal cord affected by the disease process.
Diagnosis and investigations
Myelopathy is a clinical syndrome can be
caused by much pathology. In some cases the onset of myelopathy is rapid, in
others, such as CSM, the course may be insidious with symptoms developing
slowly over a period of months or even years.
Myelopathy is primarily diagnosed by clinical examination of patient
suspected to have myeopathic features.
Some of the causes of the myelopathy can be
treated surgically. Once the clinical diagnosis myelopathy is established, the
underlying cause must be investigated. Magnetic Resonance Imaging (MRI) is the
investigation of choice in spinal and cranial disorders. MRI scan provides the
best way to visualize the spinal cord and evaluate the ongoing compression or
inflammatory disease process. Further imaging modalities like plain or dynamic
x-rays, are providing valuable information about the spinal stability and
assessment of the arthritic process affecting the disc spaces, joints or bones
of the spine. Computer Tomography is also valuable in pre-operative planning,
studying the bone anatomy as a preparation of surgical interventions.
Management
Depend on the underlying causes of the myelopathy, surgical treatment is to prevent further progression of the disease rather than treatment for existing damage of the spinal cord. Most common indications of the surgical treatment are the myelopthy related to CSM, OPLL and spinal fractures. In less common occasions, cases of vascular or infection spinal myelopathy are also an indication of surgical intervention.
Types of surgery:
The most common types of surgery to prevent
further progression of the myelopathy are:
- Anterior Cervical Discectomy and Fusion (ACDF)
- Anterior Cervical Disc Replacement ACDR,
- Anterior cervical Corpectomy,
- Cervical Laminectomy +/- fusion of the facet joints,
- Posterior cervical inter-segmental decompression of the spine.
- Thoracic laminectomy +/- spinal fusion.
- Lumbar laminectomy +/- spinal fusion.