17 Apr Myelopathy: Understanding Symptoms, Diagnosis, and Treatment Options
If you’ve been taking a closer look at how your body works and how it looks and feels, you may have recently heard of something called myelopathy. You may feel a bit confused by the word “myelopathy” and the many related terms you might hear—and you’re not alone. Many people are not familiar with myelopathy and what it is.
Myelopathy, a spinal cord illness, can affect mobility, coordination, and sensory ability. In this post, we’ll dive into not only what myelopathy is but also the various associated myelopathy symptoms, the importance of an accurate diagnosis, and the different treatment options available.
What is Myelopathy?
Myelopathy is a broad word for spinal cord neurological illnesses. It refers to a variety of medical diseases that include spinal cord injury or dysfunction. In its early stages, myelopathy can cause severe symptoms, while more severe damage can result in permanent disability.
The majority of cases of myelopathy are caused by disorders that impair the myelin sheath, which is a protective covering surrounding nerve cells, or by physical trauma to the spinal cord, such as a car accident. Myelopathy might also happen because of changes in the spine that come with getting older and are more common in older people. Several theories have been proposed, but further research is needed to determine how they induce myelopathy.
Rest, physical therapy, and surgery may be used to treat myelopathy. Treatment aims to minimize symptoms and enhance functioning for a better quality of life. Accurate diagnosis and understanding of underlying reasons can help myelopathy patients better manage and treat their condition.
Common Symptoms of Myelopathy
Myelopathy causes a person’s legs and arms to become weak and numb. This can present as clumsiness and an inability to perform fine motor tasks such as buttoning a shirt or writing with a pen. Pain or numbness in the limbs is another common sign, as is trouble walking, decreased coordination, loss of balance, or a sagging appearance to the shoulders. In severe cases, difficulty speaking or swallowing may be apparent.
Even though the effects of myelopathy vary from patient to patient based on which part of the spine was damaged, all patients experience some kind of muscle weakness. Hence, early diagnosis is crucial to reducing the risk of permanent brain damage and facilitating a speedy recovery.
Patients with myelopathy can get the right treatment to ease their pain and give them as much functional independence as possible as soon as they notice these classic symptoms and go to the doctor.
Weakness in the Legs and Lower Body
Weakness in the lower body and legs is another common manifestation of myelopathy. This type of weakness usually affects the hips, thighs, and calves. Patients may have trouble standing up, weakness while walking or jogging, and a higher risk of falling due to weak leg muscles. Complete paralysis of the legs has been seen in patients with advanced myelopathy.
It is well known that nerve damage precedes muscular weakness in myelopathy cases. The degree to which a patient experiences weakness depends on the extent of the nerve damage caused by whatever underlying condition is present. For instance, if the damage is only to the dorsal columns, then only sensory deficits may be experienced without any motor deficits.
However, the severity of muscle weakness increases if the corticospinal tract is compromised. Some individuals with myelopathic illnesses report improvement in their symptoms when they undergo cortical stimulation, specifically transcranial direct-current stimulation (tDCS).
Lower extremity weakness is a common symptom of myelopathy, although its severity depends on the etiology, requiring customized treatment regimens.
With this symptom managed for now, attention turns to relatively less understood yet vitally important symptoms resulting from myelopathies, such as loss of balance and coordination. These signs of myelopathic conditions have further implications for physical health and activities of daily living that ought to be considered when discussing treatment options for those affected by them.
Loss of Balance and Coordination
The patient’s inability to walk correctly and maintain balance may be indicative of myelopathy. Loss of balance and coordination can impair a patient’s ability to participate in activities of daily living, impacting many aspects of their life, such as simple tasks like walking. Loss of balance and coordination can further severely affect the patient’s quality of life, with a higher risk of problems resulting from falls.
When assessing patients, doctors may use the Romberg Test, which tests balance and perspective. This test is done by having two feet next to each other as a person stands and closes their eyes for 30 seconds. If the patient falls or holds their body, dehydration or myelopathy will be detected. Other tests that may be used include examining gait, using cues such as the heel-to-shin test, which checks if the patient can move the foot from heel to shin smoothly and without difficulty.
On the one hand, a decline in physical activity due to myelopathy typically progresses slowly over time. In contrast, on the other hand, rapid deterioration points potentially toward another cause, such as an acute medical condition or injury. For example, spinal tumors have been linked with accelerated bulbar onset weakness, loss of reflexes, bladder dysfunction, and upset coordination, causing imbalance.
Overall, patients should be aware that myelopathy may result in a loss of balance and coordination issues that subsequently affect their lifestyle. If symptoms arise, get medical attention to get an accurate diagnosis and treatment, which improves prognosis if myelopathy is the cause.
Diagnosing myelopathy is a complicated process that can take months of tests that are carefully thought out. Loss of balance and coordination are often key indicators of myelopathy, but they are also symptoms of many other conditions. Imaging scans and spinal taps are needed to make the most accurate diagnosis.
To diagnose myelopathy, a doctor would usually begin by obtaining a thorough history and completing a physical exam to look for stiffness or muscle weakness. This initial information can help narrow the search for the underlying cause. Imaging studies such as MRIs and CT scans are then used to look at the spine, nerves, and soft tissues for any evidence of disease or compression. If these tests do not reveal enough, specialized lab testing may be undertaken to evaluate potential infections or tumors.
Despite advancements in imaging technologies and diagnostic assays, there is substantial controversy about whether methods are acceptable for diagnosing myelopathy. Some experts advocate utilizing multiple types of tests, while others suggest operating primarily on clinical symptoms and signs. To make an informed treatment selection, visit an expert healthcare provider who understands all elements of diagnosis.
By using diagnostic tests to get as much information as possible, doctors can more confidently diagnose myelopathy and suggest personalized treatments that will give the patient the best results possible over time.
Neurological Tests and Procedures
Once the physician suspects myelopathy, they may request several neurological tests and procedures to confirm it. Commonly, a physician orders imaging studies such as an MRI to reveal possible physical abnormalities within the spinal canal.
Depending on the cause, they may also order nerve studies like electromyography (EMG) or a nerve conduction velocity study (NCV) to identify potential issues within the neurons. The doctor may perform a lumbar puncture or spinal tap, in which a needle is placed into the lower back to remove a sample of cerebrospinal fluid.
These neurological tests and procedures are thought to help reliably diagnose myelopathy. However, some argue that ordering too many tests can be costly and unnecessary since most test results won’t change how the patient is treated.
In addition, if symptoms are clear, it can be more effective to begin treatment rather than order numerous tests simply. This approach will usually reduce costs as well as limit delays on treatment plans for gradual slow progressions in mobility and other symptoms associated with myelopathy.
For those debating the costs versus benefits of ordering multiple tests to diagnose myelopathy, it should be noted that there are cases where specific tests can indeed change the scope of a treatment plan. However, cases, where this kind of information would significantly alter a course of action, must be detected quickly, as wasting time on costly procedures can have serious consequences down the line when time is of the essence.
Treatment Options for Myelopathy
Myelopathy has a wide range of potential treatments based on the kind, location, and degree of the compressive lesion that caused it.
So, patients need to collaborate with their healthcare providers to establish an effective strategy for alleviating their symptoms. Generally speaking, treatment for myelopathy can involve either surgical management or non-surgical interventions.
The main goal of any spinal surgery is to decompress the cervical spinal cord to relieve pressure and help nerves communicate better. This typically involves removing any compressing material (such as bone spurs or herniated discs) and potentially fusing vertebrae (also known as laminoplasty, which can help alleviate pain and promote mobility). In severe cases where there is significant compression causing swelling or neurologic deficits, surgical treatment may be recommended to reduce pain and improve function.
Minimally invasive spinal canal decompression surgery is the most effective treatment for myelopathy. Treatment depends on myelopathy location, spine posture, and other factors. Our spinal specialists can help you decide how to get back to living pain-free.
For the Best Spine Therapy, Contact New York Spine Experts
Controlling myelopathy pain can be challenging, but New York Spine Specialist can help. Our doctors will conduct a complete assessment to discover which conditions are causing you suffering and how serious those conditions are. We can also provide a variety of therapy alternatives to help with myelopathy pain relief and prevention.
Our doctors accept most insurance plans, including workers’ compensation (for work-related injuries) and no-fault (for auto accidents).