Cervical Spine Anatomy
The spine, also called the backbone, is designed to give us stability, smooth movement, as well as provide a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebrae and fibrous tissue called intervertebral discs.
What is Cervical Radiculopathy/Myelopathy?
Disc protrusion, also called herniated disc, is a condition caused by a tear in an intervertebral disc, allowing the disc contents to bulge out.
Disc protrusions in the cervical or neck area place pressure on nerve roots (nerve root compression) or the spinal cord causing radiculopathy. Radiculopathy is a medical term used to describe the neurological deficits that can occur from pressure on the nerves and spinal cord, such as arm or finger weakness, numbness or pain. Cervical radiculopathy refers to dysfunction of a nerve root caused by injury or compression of a spinal nerve root in the neck.
Cervical myelopathy refers to compression of the spinal cord. While compression on the nerve it causes the shooting arm pains, compression on the spinal cord is usually not painful. When the compression is on the actual spinal cord, it causes decreasing function such as balance issues and coordination issues. These might be irreversible. Some of these issues present as-difficulty standing up straight with your eyes closed, difficulty buttoning your shirt or belt, coordination issues putting on your clothes, difficulty opening jars, and decrease in your handwriting! Usually cervical myelopathy is NOT painful, but the arthritis in the neck that is contributing to the spinal cord compression IS painful.
Causes of Cervical Radiculopathy/Myelopathy
Conditions that can cause radiculopathy/myelopathy include:
- Degenerative disc disease: Wear and tear of the discs between the vertebrae, causing them to lose their cushioning ability
- Spinal stenosis: Narrowing of the spinal canal as we age, most commonly due to degenerative arthritis
- Degenerative spondylolisthesis: Degeneration (wear and tear) of the vertebral components, usually occurring after age 50, causing slippage of a vertebra onto another, spinal stenosis and narrowing of the spinal canal
Symptoms of Cervical Radiculopathy/Myelopathy
Cervical radiculopathy can result in pain, numbness, or weakness in the shoulder, arm, wrist or hand.
Cervical Myelopathy presents with weakness, problems manipulating small objects and difficulty with a normal gait.Some of these issues present as- difficulty standing up straight with your eyes closed, difficulty buttoning your shirt or belt, coordination issues putting on your clothes, difficulty opening jars, and decrease in your handwriting! Usually cervical myelopathy is NOT painful, but the arthritis in the neck that is contributing to the spinal cord compression IS painful.
Diagnosis of Cervical Radiculopathy/Myelopathy
In addition to a complete history and physical examination, your doctor willorder spine X-ray and , MRI scans. At times a CT scan, electromyography and nerve conduction studies are needed to diagnose cervical radiculopathy and myelopathy.
Treatment Options for Cervical Radiculopathy/Myelopathy
When conservative treatment measures such as rest, medication, physical therapy, and pain-blocking injections are ineffective, your surgeon may recommend spine surgery.
The most common spine surgery to relieve your symptoms of nerve root compression. A newer treatment option is now available to replace the herniated disc with artificial disc. Artificial discs are used in place of a bone fusion to preserve your neck’s movement and flexibility.
A decompressive laminectomy and fusion is a common surgery performed to treat cervical myelopathy. It is a surgical procedure in which a portion of the bone or lamina causing pressure on the nerves is removed. In spinal fusion, a piece of bone taken from another part of your body is transplanted between the adjacent spinal bones (vertebrae). As healing occurs, the bone fuses with the spine.