Understanding Spinal Cord Compression in the Neck
Cervical myelopathy is a serious condition primarily caused by compression of the spinal cord in the cervical (neck) region of the spine. It can lead to a wide range of symptoms affecting both the upper and lower body and, if left untreated, may result in permanent neurological damage.
Overview
The spinal cord passes through the spinal canal in the vertebrae. When this canal narrows due to degenerative changes, disc herniation, or trauma, it can compress the spinal cord, a condition called cervical myelopathy. Unlike cervical radiculopath, myelopathy affects the spinal cord not only the nerve roots. The radiating pain is mostly bilateral while in radiculopathy it’s mostly unilateral.
Cervical myelopathy is most common in people over 50, but it can occur earlier depending on underlying causes.
Symptoms
Symptoms often develop gradually but can worsen over time:
- Clumsiness or weakness in hands and fingers
- Difficulty with fine motor tasks (e.g., buttoning a shirt, writing)
- Balance problems or unsteady gait
- Neck pain or stiffness
- Tingling or numbness in arms or legs
- Urinary urgency or incontinence (in severe cases)
- Feeling of heaviness, fatigue or stiffness in the legs.
Because it affects the spinal cord, symptoms may involve both the upper and lower limbs.
Common Causes
- Degenerative cervical spondylosis (arthritis)
- Disc herniation
- Spinal stenosis (narrowing of spinal canal)
- Ossification of the posterior longitudinal ligament (OPLL)
- Trauma or previous neck injuries
- Congenital narrowing of the spinal canal
Medical Treatment
Cervical myelopathy requires prompt diagnosis and management to prevent permanent nerve damage.
- Imaging (MRI or CT scans) is essential for diagnosis
- Surgery is often necessary in moderate to severe cases to decompress the spinal cord (e.g., laminectomy, discectomy, fusion)
- Medications for symptom relief (pain or inflammation) may be used in mild cases or pre-surgery
Conservative treatment alone is not effective in progressive myelopathy, but physiotherapy plays a major role before and after surgery.
Physiotherapy Management
While physiotherapy cannot reverse spinal cord compression, it helps in:
- Maintaining mobility and muscle strength
- Managing secondary symptoms
- Assisting with recovery after surgical decompression
1. Pre-Surgical Physiotherapy (If symptoms are mild or awaiting surgery)
- Education on posture and spine protection
- Gentle cervical range-of-motion exercises
- Isometric neck strengthening (pain-free)
- Balance and coordination training
- Core stabilization exercises
2. Post-Surgical Physiotherapy
- Gradual mobilization under supervision
- Neuromuscular re-education
- Gait training and balance improvement
- Progressive strengthening for upper and lower limbs
- Postural correction and ergonomic advice
- Functional task training (writing, walking, climbing stairs)
Note: Physiotherapy must be carefully tailored depending on severity and post-operative status. Exercises that can aggravate the cord compression must be avoided.
Final Note
Cervical myelopathy is a potentially disabling condition. Early detection, appropriate surgical intervention, and guided physiotherapy are key to preventing permanent neurological damage and improving quality of life.
If you notice signs like clumsy hands, imbalance, or neck stiffness that progresses over time, consult a spine specialist promptly. Timely care can change the course of this condition.
