From the Guidelines
Myelopathy is a neurological condition that requires immediate medical attention, and the most appropriate initial step is to evaluate for extrinsic compression of the spinal cord using MRI, as recommended by the American College of Radiology Appropriateness Criteria 1.
Causes of Myelopathy
Myelopathy can be caused by various factors, including:
- Degenerative changes in the spine, such as cervical spondylotic myelopathy
- Herniated discs
- Spinal stenosis
- Trauma
- Tumors
- Inflammatory conditions, such as multiple sclerosis, neuromyelitis optica, and acute disseminated encephalomyelitis
- Infections, such as human T cell lymphotropic virus myelitis, tuberculosis, and syphilis
- Vascular abnormalities, such as spinal dural arteriovenous malformations
Diagnosis
Diagnosis of myelopathy involves a thorough neurological examination, imaging studies like MRI, and sometimes electrophysiological tests. MRI is the preferred imaging modality for evaluating the spinal cord and surrounding structures, as it provides superior soft-tissue resolution and multiplanar capability 1.
Treatment
Treatment of myelopathy depends on the cause and severity of the condition. For mild cases, conservative approaches like physical therapy and pain management may be sufficient, while more severe or progressive cases may require surgical decompression of the spinal cord to prevent further neurological deterioration 1.
Key Points
- Myelopathy is a neurological condition that requires prompt medical attention
- Evaluation for extrinsic compression of the spinal cord using MRI is the most appropriate initial step
- Diagnosis involves a thorough neurological examination, imaging studies, and sometimes electrophysiological tests
- Treatment depends on the cause and severity of the condition, and may include conservative approaches or surgical decompression of the spinal cord.
From the Research
Definition and Diagnosis of Myelopathy
- Myelopathy refers to any pathologic process that involves the spinal cord, and can be caused by a variety of different diseases 2.
- It is a clinical diagnosis based on symptoms and physical examination findings, with laboratories and imaging, particularly with magnetic resonance imaging, suggesting a cause 3.
- The clinical diagnosis of myelopathy requires a detailed history and physical examination to define the clinical syndrome 4.
Causes of Myelopathy
- Compressive myelopathy from degenerative disease of the vertebral column is the most common cause of myelopathy in older adults 3.
- Other causes of myelopathy include infectious, immune-mediated, nutritional, vascular, and neoplastic etiologies 3.
- Myelopathy can also be caused by spinal cord compression due to extradural masses caused by metastatic disease to bone or blunt trauma 4.
- Less common causes include primary neoplasms of the meninges, roots, or spinal cord, as well as noninfectious inflammatory processes, such as multiple sclerosis, and neurodegenerative, vascular, nutritional, or idiopathic disorders leading to myelopathy 4.
Diagnostic Approach
- MR imaging is the primary modality for evaluating the patient presenting with myelopathy 2.
- The first step in diagnosing myelopathy must be the exclusion of spinal cord compression 2.
- A thorough review of patient comorbidities, risk factors, and potential toxic exposures can help neurohospitalists distinguish between various causes and potentially start appropriate empiric therapy while awaiting definitive testing 5.
- Advances in diagnostic neuroimaging techniques of the spinal cord and improved understanding of the immune pathogenic mechanisms associated with spinal cord disorders have expanded the knowledge of inflammatory and noninflammatory myelopathies 6.
Importance of Imaging
- Neuroimaging is indicated in most instances of new-onset myelopathy, and when the worsening of a myelopathy is unexplained 4.
- Imaging can help determine the most likely cause of myelopathy and highlight a range of causes, including compressive, vascular, metabolic and toxic, infectious, autoimmune, neoplastic, and paraneoplastic causes of spinal cord dysfunction 5.
- The most appropriate imaging study and protocol should be selected in order to provide a timely and accurate diagnosis, requiring detailed knowledge regarding the strengths and limitations of the multiple imaging modalities available 4.