Cervical Stenosis with Myelopathy

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As we age, the spine may develop degenerative changes in the joints that can create tightening of the spinal canal. Over time this process may lead to pinching the spinal cord and compromise of coordination of the extremities.

Cervical stenosis is a slowly progressive condition that pinches the spinal cord. Cervical myelopathy refers to this compression of the cervical spinal cord as a result of spinal stenosis. Cervical spinal stenosis with myelopathy is more common in elderly patients.

Cervical Stenosis Symptoms with Myelopathy

People with cervical stenosis with myelopathy may note one or more of the following spinal stenosis symptoms:

• Heavy feeling in the legs
• Inability to walk at a brisk pace
• Deterioration in fine motor skills (such as handwriting or buttoning a shirt)
• Intermittent shooting pains into the arms and legs (like an electrical shock), especially when bending their head forward (known as Lermitte’s phenomenon)
• Arm pain (radiculopathy).

Often with cervical stenosis symptoms, it is the arm pain that prompts someone with this condition to seek medical treatment. At this point, the cervical stenosis with myelopathy is then discovered through medical history and physical exam.

Cervical Stenosis with Myelopathy and the Spinal Nerves

Myelopathy affects the nerve tracts that run inside the spinal cord (long tracts) and deficits in these long tracts can be picked up on physical exam.

For example:

• Muscular tone in the legs will be increased
• Deep tendon reflexes in the knee and ankle will be accentuated (hyperreflexia)
• Forced extension of the ankle may cause the foot to beat up and down rapidly (clonus)
• Scratching the sole of the foot may cause the big toe to go up (Babinski reflex) instead of down (normal reflex)
• Flicking the middle finger may cause the thumb and index finger to flex (Hoffman’s reflex)
• Compromised coordination may be evidenced by difficulty walking and placing one foot in front of the other (tandem walking).

Cervical Stenosis with Myelopathy Diagnosis

An MRI scan and/or a CT with myelogram can show the tight canal and spinal cord pinching associated with myelopathy from stenosis of the cervical spine. The spinal stenosis may be present at one or several levels in the cervical spine.

Often, cervical stenosis with myelopathy is associated with some degree of instability. Flexion/extension lateral cervical spine x-rays are useful to rule out abnormal motion and instability.

Somatosensory Evoked Potentials (SSEP), an electrical study, is done by stimulating the arms/legs and then reading the signal in the brain. A delay in the length of time that it takes to get to the brain indicates that there is a compromise of the spinal cord, either from cervical stenosis or a herniated disc.

Treatment for Cervical Stenosis with Myelopathy

The only effective cervical stenosis treatment for myelopathy is surgical decompression of the spinal canal. If the patient also has a radiculopathy (myeloradiculopathy), conservative treatment like NSAIDS, activity modification and exercises for cervical stenosis may help relieve the arm pain.

Myelopathy is a generally progressive condition that develops slowly. Cervical spinal stenosis symptoms with myelopathy may not progress for years, and then difficulties with coordination may suddenly increase. Unfortunately, the symptoms rarely improve without cervical stenosis surgery to decompress the affected area.

Cervical Stenosis Surgery

A cervical spinal stenosis surgery involving decompression may or may not improve the symptoms. Typically, the main goal of this cervical spinal stenosis treatment is to arrest the progressive nature of the condition and stabilize the patient’s neurological condition.

Cervical stenosis surgical decompression can be performed through an anterior (front) approach or posterior (back) approach. The type of approach for cervical spinal stenosis is generally dependent on the surgeon’s preference and where the majority of the compression is located (in the front or back).

Often, multiple levels need to be decompressed, so the cervical stenosis surgery tends to be more involved than that for cervical herniated discs or cervical foraminal stenosis.

• Article written By:
• Peter F. Ullrich, Jr., MD

August 7, 2009

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