Myelopathy

Wear or herniated discs on the cervical spine can lead to degenerative limitations of the spinal cord with neurological deficits. Doctors speak of one Myelopathy.

What is myelopathy?

The medical term Myelopathy or cervical myelopathy is made up of the Greek words "myelon" = spinal cord and "pathos" = pain and stands for damage to the spinal cord in the area of ​​the spine.

The damage to the spinal cord can lead to a number of complaints such as unsteadiness, numbness and other neurological problems.

The cervical spine is most commonly affected, but myelopathy can occur elsewhere in the spine.

causes

The main cause of myelopathy is a narrowing of the spinal cord, which can be congenital but in most cases it is acquired during life. The degenerative changes that lead to myelopathy can be traumatic in nature and triggered by accidents or falls, but they can also result from inflammation, tumor diseases or changes after an operation such as scarring.

In most cases, myelopathy is triggered by degenerative changes and wear and tear in the affected area of ​​the spine. They narrow the spinal cord and irritate the nerve roots. Various types of herniated discs can also lead to stenosis of the spinal cord.

Symptoms, ailments & signs

Typical symptoms of myelopathy are neck pain that radiates into the arms, sometimes numbness and a feeling of weakness in the arms.
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Typical symptoms of myelopathy are neck pain that radiates into the arms, sometimes numbness and a feeling of weakness in the arms. Arms and hands can fall asleep at night. A first sign can be a stiff neck and a restricted ability to turn the head to the left or right.

If the spinal cord is already damaged, the symptoms can also radiate into the legs and lead to uncertainty when walking and impairment of the bladder and intestines. An important sign of identification is the feeling of an electric shock that can occur when the head is bent (Lhermitt's sign). The further the disease has progressed, the more neurological failures can occur. These include pins and needles, tingling, pain, walking, problems with coordination and problems with everyday activities such as tying shoes or putting on a jacket. In severe cases, paralysis, bladder, bowel and potency disorders can occur.

Diagnosis & course of disease

The most important way to diagnose myelopathy is magnetic resonance imaging (MRI). It shows degenerative changes most clearly with a pressure on the spinal cord. If extensive ossification has to be treated, a computed tomography (CT) is an indispensable aid for the representation of the bones, in order to be able to plan and assess the operation process better.

In order to prevent an unfavorable course in good time, diagnosis as early as possible is important. In patients with acute symptoms after a herniated disc, the chance that the symptoms will regress is greatest if the herniated disc is diagnosed immediately. Changes to the bones can be slow and gradual and sometimes go unnoticed or associated with other problems.

In an MRI scan, degenerative changes in the cervical spine with changes in the cervical spinal cord can be clearly seen. Treatment of myelopathy depends on the extent of the damage.

Complications

Myelopathy causes severe neurological deficits in the patient. These failures can lead to paralysis and further disorders of sensitivity and thus significantly reduce the patient's quality of life.Movement restrictions continue to occur, so that patients may need the help of other people in their everyday lives. Those affected mainly suffer from severe pain in the neck and also from a stiff neck.

As a result, turning the head is associated with pain. There are also problems with coordination and concentration. The pain can limit everyday life and, in the form of resting pain, also lead to sleep problems at night. It is not uncommon for myelopathy to lead to problems with potency.

The disease also affects the intestines and bladder. It is not uncommon for those affected to develop psychological complaints. The life expectancy of the person affected by the myelopathy may also be restricted by the underlying disease. In many cases, the damage is irreversible and treatment cannot take place.

However, various therapies can alleviate the symptoms. However, in most cases there is no complete healing of the myelopathy. There are usually no further complications during treatment.

When should you go to the doctor?

Pain in the back or cervical spine should always be clarified by a doctor. If the symptoms have existed for a long time and get worse over time, there may be a serious disease such as myelopathy, which must be medically diagnosed and treated therapeutically. Affected people are best advised to consult their family doctor. They can make an initial diagnosis and refer the patient to an orthopedic surgeon if necessary.

The actual treatment is carried out by various specialists and a physiotherapist. Depending on the severity of the disease, surgical measures must also be initiated. People who already have back problems are particularly at risk of developing myelopathy. Older people and people with malformations of the back or spine are also among the risk groups and should speak to a doctor at an early stage. The therapy is lengthy and the patient has to be examined regularly so that complications can be excluded and, if necessary, treated directly. In addition, regular adjustment of the medication is necessary.

Treatment & Therapy

In most cases, conservative treatment is not enough because it does not eliminate the cause, the bruising of the spinal cord. Bruising of the spinal cord and changes to the bones usually cannot resolve on their own. A herniated disc can regress and does not always have to be operated on, but it takes a lot of time.

However, if the incident caused damage to the spinal cord, surgery will have to be carried out, otherwise the symptoms will not go away. Conservative therapy may sometimes be necessary if patients cannot be operated on because of their age or because of comorbidities. It involves the administration of pain reliever, decongestant, and anti-inflammatory drugs. If necessary, a neck brace and bed rest must be prescribed.

If there is no pain, physical therapy will help stabilize the cervical spine. During conservative treatment, the course must be closely monitored in order to quickly identify possible deterioration. If neurological impairments or failures occur, an operation to relieve the spinal cord is inevitable. The operation must always be carried out in an inpatient setting; before the operation, an attempt is made to use infusions or medication to induce swelling of the spinal cord.

During anesthesia, care must be taken to avoid overstretching the head when positioning the patient so as not to squeeze the spinal cord even more. The operation is usually performed from the front, but also from the rear if the findings are appropriate. Decongestant medication will continue to be required for several days after the operation. This is usually followed by rehabilitation with exercises to reduce the symptoms. Often they cannot be completely cured.

Outlook & forecast

The prospects for myelopathy are mixed. Basically, the best chances of recovery exist with an early diagnosis and a subsequent start of therapy. In practice, however, it usually turns out to be problematic that the disease progresses insidiously. There are insufficient early detection signals. This means that neurological deficits and changes in the bones can no longer be corrected. Doctors therefore often speak of the insidiousness of myelopathy. The quality of life suffers. The progressive form leads to ever greater complaints if it is not treated.

Acute myelopathy usually brings with it the chance that the symptoms will regress completely. The medical effort is low, depending on the patient's basic condition. If tumors or other diseases trigger myelopathy, the success of the treatment depends crucially on combating these causes.

After an operation, rehabilitation usually takes several weeks. If necessary, load restrictions must be accepted in everyday life. Back-friendly behavior and strengthening of the muscles are essential. Some patients have to rely on medical devices for the rest of their lives if the disease is severe. If necessary, permanent supervision is necessary.

prevention

As with most spinal diseases, myelopathy can be effectively prevented by avoiding one-sided movements and chronic poor posture. People who work in the office and have to sit at desks and computers a lot should regularly do exercises to relieve the cervical spine.

Regular physical exercise strengthens the back muscles and relieves back problems. In the case of mild complaints, physiotherapy exercises help to prevent chronic malpositions in good time and to relieve the spine.

Aftercare

In most cases, patients with myelopathy have only very limited and only very few direct follow-up measures available. The person concerned should therefore consult a doctor at an early stage so that other complications and complaints do not occur. The earlier a doctor is consulted, the better the further course of the disease is usually.

If the person concerned wishes to have children, he or she should first consider genetic testing and counseling in order to prevent the disease from recurring in the children. Most of those affected are dependent on the measures of physiotherapy or physiotherapy for myelopathy. Many of the exercises can also be performed in your own home.

Many sufferers are dependent on taking various medications. The person concerned should always rely on the correct dosage and regular intake. If anything is unclear or if you have any questions, the person concerned should always first contact a doctor in order to avert possible complications and complaints in advance.

You can do that yourself

The measures myelopathy patients can take in everyday life depend on the cause and severity of the disease. If the underlying reason is just a herniated disc, the symptoms can be alleviated by professionally guided physiotherapy. The patient can support the therapy at home with individual exercises. Moderate movement will help prevent the disc from slipping out again.

If an operation is necessary, the person concerned primarily needs rest. The procedure usually puts a lot of strain on the spine, which is why strenuous physical activity should be avoided in the first day after the operation. If necessary, the patient must wear a neck brace and initially walk with crutches. If pain occurs, a relatively strong pain reliever must be used to avoid bad posture and the resulting damage. The patient can support the medication through various means from naturopathy. In addition to valerian drops, preparations such as arnica or devil's claw have also proven themselves. A hot bath helps with acute pain.

In parallel with these measures, a doctor must monitor the course of the disease. If complications arise, the doctor must be informed about them. Myelopathy may be caused by a tumor or inflammation that needs treatment first.