Cervical Myelopathy

Cervical myelopathy is a serious condition that occurs when the spinal cord in the neck becomes compressed.
This pressure can disrupt the signals between the brain and body, leading to problems with balance, coordination, strength, and fine motor skills.

Unlike nerve root compression, which primarily causes pain, cervical myelopathy often develops gradually and silently, sometimes without significant neck pain, making early diagnosis especially important.

Cervical myelopathy is most often caused by degenerative changes in the spine.
As we age, the structures of the cervical spine can wear down and narrow the space around the spinal cord.

Common causes include:

• Cervical spinal stenosis – narrowing of the spinal canal due to bone spurs, thickened ligaments, or disc degeneration.
• Herniated discs – disc material bulges or leaks into the spinal canal, pressing on the cord.
• Arthritis or bone spurs that reduce space around the cord.
• Congenital factors – some people are born with naturally narrow spinal canals.
• Trauma or injury – sudden damage can lead to instability or compression.
• Spinal tumors or cysts, though less common.

Cervical myelopathy symptoms often develop slowly over time and may be subtle in the early stages.
Because they involve the spinal cord, these symptoms tend to be more widespread than those of a pinched nerve.

• Clumsiness or weakness in the hands /Loss of fine motor skills– difficulty buttoning shirts, writing, or handling small objects.
• Balance and coordination problems – unsteady walking or frequent tripping.
• Neck stiffness or mild discomfort, though pain is not always present.
• Arm or leg weakness that may feel like heaviness or fatigue.
• Numbness or tingling in the arms, hands, or legs. 
• Severe or urgent symptoms: sudden bladder or bowel dysfunction or rapid worsening of walking ability — these require immediate medical evaluation.

Early and accurate diagnosis is critical to prevent permanent spinal cord damage.
Dr. Fried uses a thorough evaluation process that includes:

• Detailed medical history to understand symptom progression and lifestyle impact.
• Physical and neurological exam to assess reflexes, strength, sensation, coordination, and gait.
• Imaging studies:
  •  X-rays: Show bone spurs, alignment issues, or instability. 
  • MRI: Best for visualizing spinal cord compression and soft tissue changes.
  • CT scans: Occasionally used for detailed bone evaluation in complex cases.
     

Cervical myelopathy typically does not improve on its own, and the goal of treatment is to prevent stepwise decline.
Dr. Fried’s approach focuses on surgical decompression when necessary, often using minimally invasive or motion-preserving techniques.