Cervical Myelopathy

Cervical myelopathy is a condition in which the spinal cord in the neck is compressed, disrupting the transmission of signals between the brain and the rest of the body. It is the most common cause of spinal cord dysfunction in adults over 55 and can lead to progressive neurological deterioration if left untreated.

Cervical myelopathy is the most serious consequence of cervical spine degeneration. It develops when Spinal Stenosis in the cervical spine becomes severe enough to compress the spinal cord itself — driven by Degenerative Disc Disease, Disc Herniation, and Facet Disease. It is the cervical analog of Cauda Equina Syndrome in the lumbar spine, and like cauda equina, it represents a condition where timely diagnosis and treatment are critical to preventing permanent neurological injury.

Causes

Degenerative cervical spine disease.

The most common cause is the cumulative effect of cervical spine degeneration — including disc herniations, bone spur formation, thickening of the ligamentum flavum, and facet joint hypertrophy — which progressively narrow the spinal canal and compress the spinal cord. This process is often referred to as cervical spondylotic myelopathy.

Other causes

Less commonly, cervical myelopathy can result from ossification of the posterior longitudinal ligament (OPLL), congenital spinal canal narrowing, spinal tumors, inflammatory arthritis (particularly rheumatoid arthritis involving the upper cervical spine), traumatic injury, or infection.

Symptoms

Symptoms of cervical myelopathy are often insidious in onset and may be mistaken for normal aging. They include hand clumsiness and difficulty with fine motor tasks such as buttoning a shirt or writing, weakness and heaviness in the arms or legs, an unsteady gait and balance difficulties, neck pain and stiffness, and in advanced cases, bowel or bladder dysfunction. Lhermitte's sign — an electric shock-like sensation running down the spine with neck flexion — may also be present.

Diagnosis

A detailed neurological examination assesses upper and lower motor neuron signs including hyperreflexia, the Hoffman sign (involuntary finger flexion with flicking), clonus, and the Babinski sign. Gait assessment is important as myelopathic gait is often wide-based and unsteady.

A cervical spine MRI is the gold-standard imaging study, demonstrating the site and degree of cord compression and any intrinsic cord signal change (T2 hyperintensity), which indicates cord injury. CT myelography may be used when MRI is contraindicated or for surgical planning.

Severity Classification

The modified Japanese Orthopaedic Association (mJOA) scale is commonly used to grade the severity of cervical myelopathy and guide treatment decisions.

• Mild (mJOA 15–17): Minimal functional impairment — close observation may be appropriate.
• Moderate (mJOA 12–14): Noticeable functional deficits affecting daily activities — surgery is often recommended.
• Severe (mJOA less than 12): Significant neurological dysfunction — surgical decompression is strongly indicated.

Treatments

Unlike many degenerative spinal conditions, cervical myelopathy rarely improves with conservative treatment alone, as the underlying spinal cord compression tends to progress over time. Early recognition and intervention are critical to preventing permanent neurological injury.

Mild cases may be monitored closely with serial neurological examinations and imaging, but any sign of progression is a strong indication for surgical intervention.

Conservative treatment: While not curative, activity modification, cervical collar use during flares, physical therapy for strengthening and balance, and pain management can help stabilize mild symptoms in carefully selected patients who are not surgical candidates.

Surgical treatment

Surgery is the definitive treatment for moderate to severe cervical myelopathy and is aimed at decompressing the spinal cord and stabilizing the spine. Surgical approaches include anterior cervical discectomy and fusion (ACDF), cervical disc replacement, posterior laminectomy with or without fusion, and laminoplasty — a motion-preserving technique that expands the spinal canal from the back. The choice of approach depends on the number of levels involved, the location of compression, and spinal alignment. Surgery halts progression in the majority of patients, and many experience meaningful neurological recovery.

Related Spine Conditions

• Spinal Stenosis
• Degenerative Disc Disease
• Disc Herniation
• Facet Disease
• Foraminal Stenosis
• Back to all Spine Conditions