What it is
Myelopathy is compression of the spinal cord itself, usually from a combination of disc bulging, bone spurs, thickened ligament and a congenitally narrow canal. Unlike a pinched nerve root, it tends to progress in steps rather than smoothly, and the function it takes does not always come back.
This is the cervical diagnosis Dr. Long would rather see early than late.
Symptoms
- Clumsiness with fine tasks — buttons, coins, keys, handwriting
- Dropping objects, or a vague sense the hands no longer do what they are told
- Unsteadiness walking, a wider stance, difficulty on stairs or in the dark
- Numbness in both hands
- Later: changes in bladder control
Neck pain may be mild or entirely absent, which is one reason the diagnosis is frequently missed for months.
How it is diagnosed
The examination is specific: brisk reflexes, a positive Hoffmann's sign, a positive Romberg test, and an abnormal gait. MRI confirms the compression and may show signal change within the cord itself. Dr. Long will assess how much of the deficit is established and how much is still at risk, because that is what determines the timing.
Non-surgical treatment
There is no non-operative treatment that reverses cord compression. For mild, stable, non-progressive myelopathy, careful observation with regular re-examination is reasonable. Physical therapy can help balance and function but does not address the cause.
When surgery is considered
Early, in most cases of moderate or progressive myelopathy. The purpose of the operation is to stop the decline and create room for the cord. How much function returns afterwards varies and depends heavily on how long the compression has been present — which is the argument for assessing it sooner rather than watching it.