Cervical myelopathy is the arthritic compression of the cervical cord basically due to wear and tear. It is usually associated with previous cervical tightness or other factors so that as a whole it is multifactorial, but basically it is arthritic.
The main symptom is cervical pain and it is accompanied by a series of very frequent manifestations in older people such as gait instability, difficulty in handicrafts, loss of strength, sphincter disorders and in the later stages, alteration of sensitivity.
How is it diagnosed?
Basically, cervical myelopathy is diagnosed by physical examination of the patient. During the visit to the neurosurgeon, he or she will examine the patient and determine a series of symptoms that are unequivocal of spinal cord compression. From this moment on, complementary explorations must be carried out and the ones that are specific to this process are basically the evoked potentials in the electromyography, the cervical functional X-rays, moving X-rays, and basically the MRI in which we will see an image of a spot in the spinal cord that corresponds to the place of compression.
What is the current treatment?
Surgical treatment is currently the treatment of choice. It has been demonstrated in multicenter studies that conservative treatment does not stop the disease and that more than 50% of patients will end up with a high degree of disability. The classic surgical treatment, considering that the compression comes in front of the spinal cord, consists of an anterior approach, which is called an anterior cervical arthrodesis.
Although recently work has appeared in which cervical prostheses can be used, which is called arthroplasty, all this is still under study.
When the myelopathy is very extensive, involving more than 3 levels, the number of complications associated with an anterior approach is high, so that a subsequent approach to the spine can be considered.
Recently, advances in navigation and especially intraoperative monitoring of patients allow us to place screws with high precision in the cervical pedicles, which gives great rigidity to the system and the impossibility that the surgery can be damaged later with the passage of time. Therefore the treatment is eminently surgical.
What are the results?
As we have already mentioned, the normal evolution of the disease is in 50% of the cases to great disability, in the form of tetraparesis or tetraplegia. Nowadays, intraoperative monitoring techniques and navigation above all allow us to perform this surgery safely, both anteriorly and posteriorly, and we obtain much better results than before, and in 50% of the cases we stabilize the patient so that the disease no longer progresses.
In addition, in 30% of cases we achieve an acceptable and significant motor recovery with a change in the patient’s quality of life, and only in 20% of cases the patient continues to worsen, manifesting the progression of his cervical osteoarthritis. Therefore, surgical treatment is the most recommended treatment in these cases.