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Cervical Myelopathy Adelaide

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Overview

Cervical and thoracic myelopathy are compression of the spinal cord in the neck or thoracic area respectively, usually due to degenerative changes such as disc bulging or bone spurs. Symptoms may include clumsiness of the hands, gait disturbance, weakness or loss of fine motor control. Early diagnosis and treatment are important to prevent progressive neurological decline.

Symptoms

  • Hand clumsiness, difficulty with fine motor tasks (buttoning, writing, using utensils).
  • Progressive weakness in the arms or legs.
  • Gait disturbance, balance problems or wide-based walking.
  • Stiffness and spasticity (sustained muscle tightness).
  • Numbness or tingling in arms, hands, legs or feet.
  • Neck pain (may or may not be present).
  • In severe cases, bowel or bladder dysfunction.

Myelopathy typically has an insidious onset and may progress in a stepwise manner; early recognition is important.

Diagnosis

Early and accurate diagnosis is critical to prevent irreversible neurological damage.

  • Neurological examination: detailed testing of limb function, strength, reflexes, gait and sensation.
  • MRI: the gold standard; shows cord compression, cord signal changes and degree of stenosis.
  • X-rays: assess alignment and degenerative changes; dynamic (flexion-extension) views may show instability.
  • Sometimes CT or CT myelography: further imaging if MRI findings are unclear or contraindicated.
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Non‑surgical treatment

Conservative treatment alone is often insufficient for myelopathy; it may slow progression in mild cases but does not reverse cord damage.

  • Activity modification: avoiding neck extension and high-impact activities that may worsen compression.
  • Medications: anti-inflammatories and neuropathic pain medicines for symptom management.
  • Physiotherapy: gentle neck exercises, postural support and stabilisation work.
  • Cervical collar: may provide temporary symptom relief; typically short-term use.
  • Close monitoring: regular clinical and imaging follow-up to detect progression.

Surgical treatment

Surgery is strongly recommended for moderate to severe myelopathy or if symptoms are progressive, as conservative care does not stop cord damage progression.

  • Anterior cervical decompression and fusion (ACDF) or vertebrectomy: removal of discs and/or bone spurs via the front of the neck with fusion.
  • Posterior laminectomy or laminectomy and fusion: removal of bone at the back of the vertebrae to decompress the cord from behind; fusion may be added to maintain stability.
  • Posterior thoracic decompression and fusion
  • Transthoracic decompression and fusion: spinal cord decompression requiring partial removal of rib and through the chest cavity.
  • Hybrid approaches: combining anterior and posterior techniques.

Early surgery may prevent further deterioration and may improve function in some patients; delayed surgery may result in permanent neurological deficits.