From the Guidelines
Cervical myelopathy is a serious neurological condition that requires prompt evaluation and treatment to prevent permanent spinal cord damage, and the most recent evidence suggests that MRI imaging is the ideal diagnostic tool for evaluating the spinal cord and surrounding structures 1, 2.
Diagnosis and Evaluation
The diagnosis of cervical myelopathy typically involves a combination of physical examination, medical history, and imaging studies. According to the American College of Radiology (ACR) Appropriateness Criteria, MRI is the preferred imaging modality for evaluating the spinal cord and surrounding structures in patients with suspected myelopathy 2.
- MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluating the spinal canal and its contents, as well as the surrounding osseous and soft-tissue structures.
- Intramedullary cord signal changes on MRI can represent prognostic factors for neurosurgical outcome in patients with spondylotic myelopathy 2.
- Diffusion-weighted imaging can show signal alteration in the spinal cord earlier after symptom onset compared with T2-weighted images, making it a useful tool for evaluating spinal cord ischemia 2.
Treatment and Management
Treatment for cervical myelopathy depends on the severity of the condition and the underlying cause. Surgical decompression of the spinal cord is often required in moderate to severe cases, while conservative management with physical therapy, pain medications, and activity modification may be appropriate for mild cases or patients who cannot undergo surgery 1.
- Early diagnosis and treatment are crucial for preventing irreversible neurological deficits.
- The condition differs from radiculopathy, which affects nerve roots rather than the spinal cord itself, and requires specialized evaluation by a neurosurgeon or orthopedic spine specialist to determine the optimal treatment approach.
- In patients with inflammatory or infectious etiologies of myelopathy, visualization of the osseous spinal column as well as the spinal cord is useful and best accomplished noninvasively by MRI 2.
From the Research
Definition and Treatment of Cervical Myelopathy
- Cervical myelopathy is a condition characterized by progressive neurological decline due to compression of the spinal cord in the cervical spine 3.
- The treatment of cervical myelopathy typically involves surgical decompression to relieve pressure on the spinal cord and prevent further neurological deterioration 4, 5, 3, 6.
Surgical Approaches for Cervical Myelopathy
- There are several surgical approaches for treating cervical myelopathy, including anterior cervical decompression and fusion, posterior laminoplasty, and multilevel cervical discectomy and fusion 4, 5, 3, 6.
- Each approach has its advantages and disadvantages, and the choice of approach depends on patient characteristics, such as the number of involved levels, site of compression, and cervical alignment 3.
- Studies have compared the outcomes of different surgical approaches, with some showing similar results between anterior and posterior approaches 6, while others highlight the importance of considering individual patient factors when selecting a surgical approach 3.
Non-Surgical Management of Cervical Myelopathy
- Non-surgical management of cervical myelopathy is generally not recommended for patients with moderate to severe symptoms, as it can result in inferior outcomes compared to surgery 7.
- However, non-surgical management may be considered for patients with mild symptoms, although the evidence for its effectiveness is limited 7.
- The natural history of cervical myelopathy is unpredictable, and patients without myelopathy with spondylotic cord compression are at risk of developing myelopathy over time 7.
Outcome Measures and Complications
- Outcome measures for cervical myelopathy include the Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and visual analog scale for neck pain (VASNP) 6.
- Complications can occur with any surgical approach, and studies have reported varying rates of complications, such as hematoma, vocal cord paresis, and dura leak 6.