Ask the Expert: Cervical Myelopathy

by Dr. Han Jo Kim
11.27 Blog

Dr. Han Jo Kim, Orthopedic Spine Surgeon, answers readers’ questions on cervical myelopathy.

Q1. What is Cervical Myelopathy?

Cervical Myelopathy is a disease where patients can develop balance problems impeding walking, a loss in manual dexterity as well as problems with bowel and bladder function.  These symptoms can be accompanied by numbness, tingling and/or weakness in the arms and/or hands.  It has an insidious course where patients can plateau in their symptoms, but overall, it is a progressive condition.

Q2. What causes cervical myelopathy?

Cervical myelopathy can be caused by a number of conditions that result from spinal cord compression.   Some relatively common causes are severe osteoarthritis of the cervical spine (cervical spondylotic myelopathy – CSM) and ossification of the posterior longitudinal ligament (OPLL).

Q3. What are the most common symptoms of cervical myelopathy?

Usually patients with cervical myelopathy will present with balance and coordination problems making walking difficult and with manual dexterity problems (such as difficulty to button shirts).  In some cases, patients can also develop problems with bowel and bladder function.  These symptoms can also be accompanied by numbness, tingling or weakness in the upper extremities.

Q4. What are the common treatments for cervical myelopathy?

The common treatments for cervical myelopathy include surgical and non-surgical options.  Non-surgical options include the use of oral corticosteroid therapy.  This can result in a transient improvement in the symptoms of cervical myelopathy.  Definitive treatment of cervical myelopathy is a decompression of the spinal cord via an anterior and/or posterior approach.  The decision to have surgery via the different approaches will depend on where the compression of your spinal cord is as well as the overall alignment of the cervical spine and finally, patient factors.  This will be determined by your surgeon.

Q5. Are there any advancements or new research that will change how cervical myelopathy is treated in the future?

Recent research into the use of the medication Riluzole on patients with myelopathy may be promising.  This drug might help the spinal cord recover from the injury it has sustained from being compressed and might be useful as a medication to help the spinal cord recover after surgery to decompress the spinal cord.  Further research is necessary to demonstrate its efficacy in humans, but preliminary animal studies have been promising.

Dr. Han Jo Kim is an Orthopedic Surgeon at Hospital for Special Surgery, specializing in Cervical Spine and Scoliosis Surgery. As the Co-director of Research and Education for the Scoliosis Service, he is a lead investigator for numerous research studies and has won multiple awards in the national and international arena. Dr. Kim has also volunteered time as a surgeon at the FOCOS hospital in Ghana, West Africa where he has successful operated on over 50 rare and complex spinal deformities.

Topics: Featured, Orthopedics
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

steve grier says:

I had cervical surgery in 2009, did not help my walking, was told I have cervical myelopathy, was told there nothing doctors can do for me, today I use a walker, chronic pain, each day I feel like I have a case of the flu, fatigue, I try and exercise at least 5 days per week, nothing I do seems to improve my situation, please advise, thank you Steve Grier

HSS on the Move says:

Hi Steve, thank you for reaching out. Please reach out to our physician referral service at 877-606-1555 and they can help you set up an appointment.

Lou says:

I was diagnosed with cervical myelopathy 5 days ago. I present few symptoms. In fact, the condition was found by accident. As an active 35 year old (marathoner, triathlete, skier, etc.), what activities should I avoid and what activities can I continue? Everything I read focuses on elderly patients and does not address the condition for active adults. Any direction, articles, etc. is greatly appreciated.

HSS on the Move says:

Hi Lou, thank you for reaching out. Dr. Han Jo Kim, Orthopedic Surgeon, says “It is difficult to give any advice without physically examining you or reviewing the imaging. My advice would be to see a spine surgeon as soon as possible who can follow you closely so that if symptoms progress or her condition worsens, something can be done about it expeditiously. Most likely, the surgeon will not recommend surgery and would advise you to continue your current lifestyle without limitations unless there are certain symptoms which warrant further intervention or activity modification.” It is best for you to consult with your treating physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

steve grier says:

Good day, I tried calling the number listed above and no one could help me, as I am living in Green Valley, Arizona, can you refer me to a doctor in my area or must I come to New York? I am desperate for some type of treatment, if it is possible. If I must travel to New York, what am I looking at as far as cost is concerned and what about insurance? Thank you, Steve Grier

HSS on the Move says:

Hi Steve, thanks for reaching out. We have sent your question to Westley Holiday, Coordinator of HSS’ Coast to Coast Program. You should receive a response shortly.

Richard Showalter says:

Hello, I have been diagnosed with Cervical Myelopathy. I work out at the gym 3 days a week, I have noticed that when i am setting i can leg press 250 lbs but when i am standing i can barely move my legs. Am i releaving some pressure on my nerves when i sit. If that were the case then my problem must be in my back vs. in my neck thank u

HSS on the Move says:

Hi Richard, thank you for reaching out. Dr. Han Jo Kim, Orthopedic Surgeon, says: “If you don’t already have one, it would be beneficial to have an MRI of your cervical spine and/or lumbar spine. I would recommend being reevaluated by a spine surgeon. Position related compression can occur, but it will depend on the type and location of pathology.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Ellen Feduik says:

I was diagnosed 6 wks ago w/CSM. I have ALL of the symptoms and have involvement in all 7 vertebra, with 5 areas of needed decompression. I have no doubt that surgery is my only option. The surgeon said this is “urgent and severe. Much to the surgeons objection I chose to spend the last 6 weeks in P.T. & w/a personal trainer at my gym. I have improved core strength considerably and some posture improvement as well. Question: Have I improved my chances of a better overall outcome having done this…..as my surgeon stated prior to my doing all of this, that I have only a 60% chance of improvement and that he feels his best result will be to stop and/or hinder the progression. What say you? Thank you for your input.

HSS on the Move says:

Hi Ellen, thanks for reaching out. Dr. Han Jo Kim, Orthopedic Surgeon, says: “Depending on the severity of your spinal cord compression and symptoms, not all CSM cases are urgent. If you are doing well, you are probably headed in the right direction and yes, likely to have a better recovery. In regards to how well your spinal cord will recover, it depends on many variables that studies have not quite elucidated at this time. Also, many cases of CSM can have a full and complete recovery. To give a more clear answer, an evaluation with a physician would be needed and your imaging would need to be seen as well.” It is best for you to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Anna M says:

Hi there I am a Brit using the National Health Service. I have 5 levels of disc prolapse with myelopathy and parethesis. I currently have neck pain, leg hyper-reflex, not much reflex in my arms. I stumble a-lot and find difficulty writing/ opening jars. I also keep twisting my ankle due to the numbness on the outside of my feet. I am otherwise an active 36 year old woman…and would like to continue to be!. I have been offered spinal intervention in the shape of a complete fusion (currently in denial of this!!) Unfortunately due to the fabled “waiting lists” issue with the National health and the fact that in most cases surgery does not cure the problem merely stops progression,I am therefore worried that my condition will severely degenerate in the 7 months it will take to get me to surgery. Are there any papers at all on the risks associated with waiting for this type of surgery that you could point me to? Many thanks

HSS on the Move says:

Hi Anna, thanks for reaching out. For more information on spinal fusion, click here: http://www.hss.edu/condition-list_spinal-fusion.asp.If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance. For more information, visit http://www.hss.edu/physician-referral-service.

helen w says:

I’ve been working with another spine center in NYC for about a year but am feeling pushed into a “one size fits all” program including being presented with cervical epidural as my only next option – this despite the fact that I’ve had this procedure before from the same place and had a very bad reaction and little relief of pain.
I’ll leave out my various digagnoses here but short version is spondylosis, degenerative disc disease mostly cervical spine, etc.

Considering looking into a second opinion but not sure where to start.

Thank you.

HSS on the Move says:

Hi Helen, thank you for reaching out. It is best to seek an in-person consultation with a physician so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

helen w says:

Thank you. Do you know whether there is a charge for in-person initial consultation?

helen w says:

Disregard previous – I’ve contacted the PRS. Thank you!

Don Lyon says:

3 yrs ago I had tingling an numbness in my left foot. That progressed into my being off balance; walking is stilted. More recently have experienced upper body weakness. I exercise daily and had PT off and on for the past 2 yrs. My condition continues to deteriorate. Recent MRI’s and CT show movement between C4 & C5 – surgery is recommended. Would like to know if there are any other options. Thank you.

HSS on the Move says:

Hi Don, thank you for reaching out. Dr. Han Jo Kim, Orthopedic Surgeon, says: “Depending on your condition, I believe surgery should be done sooner than later. If you have cervical myelopathy, the spinal cord damage you get can be irreversible. It is hard to comment specifically on your condition without looking at your MRI or your other radiographic images. You may benefit from seeking a second opinion.” It is best for you to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Teresa Kramer says:

I have been diagnosed with cervical stenosis, ossification of the cervical ligament & had a C3-4fusion two years ago. Prior to the fusion I had some symptoms but they actually increased after the fusion. sept 2013 overnight my left calf and ankle no longer functioned correctly it”s taken a year to regain some of my normal strength. My neurosurgeon has strongly suggested another fusion @c4-5 which seems to be a fulcrum and weak point where an osteophyte is impinging on my spinal cord I am so reluctant to go through this again and would like a second objective opinion. It is an elective surgery and does not deal with the ossification on the posterior cervical ligament. Please advise. Thank you!

HSS on the Move says:

Hi Teresa, thank you for reaching out with your question. Dr. Han Jo Kim, Orthopedic Surgeon, recommends you be evaluated by a physician. If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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