Cervical Myelopathy: Spinal Cord Compression Symptoms, Risks, and Treatments

Degenerative Cervical Myelopathy (Cervical Myelopathy, or simply "DCM") is a condition defined by compression or pinching of the spinal cord in the upper part of the spine. DCM is the leading cause of spinal cord dysfunction across the world (1). This article discusses the symptoms commonly associated with DCM, some of the risks associated with myelopathy, and the most frequently recommended treatment options available.

By definition, DCM results from degenerative changes or the breakdown of the upper spine's alignment and support over time. All of the symptoms of the disease result from either these changes themselves or from resulting pressure on the spinal cord (2). Associated symptoms commonly include:

• Neck stiffness and/or pain
• Difficulty with tasks like buttoning a shirt, writing
• Wide, unsteady gait (abnormal walking)
• Numbness or tingling in the arms/legs

More severe presentations can lead to further loss of spinal cord function. Individuals with the following "red flag" symptoms should seek care immediately from a licensed healthcare professional:

• Weakness in the legs, particularly if worsening
• Loss of bowel/bladder control

For patients with mild disease (limited changes to sensation/coordination, and limited decrease in day-to-day activities), data remains unclear as to whether conservative monitoring or early surgical intervention is better (1). However, in patients with moderate to severe disease (and increasingly in those with mild disease), early referral to a spine surgeon is essential. In surgery, the primary goal is to reduce compression of the spinal cord, however many approaches are available and individuals seeking surgery for DCM should discuss which option may be best for them with a Spine Surgeon. Some of the possible procedures for relieving DCM include:

• Anterior Cervical Discectomy and Fusion (ACDF)
• Anterior Cervical Corpectomy and Fusion (ACCF)
• Laminectomy with Fusion
• Laminoplasty with Fusion

Recent data suggests that anterior approaches may result in less neck pain compared to laminectomy and laminoplasty, however the best procedure for each patient depends on many factors (5). For more information on the above procedures, click the provided hyperlinks.