Cervical myelopathy results from a narrowing (stenosis) around the spinal cord in your neck. It is usually caused by degeneration and arthritis of the bones, ligaments and joints in your neck. It is also known as cervical spondylotic myelopathy or degenerative cervical myelopathy (DCM).

Froedtert & MCW specialists have experience diagnosing and treating cervical myelopathy. We have developed a unique post-surgical rehabilitation program to manage your recovery and symptoms.

These images show the pinched spinal cord in the neck that is indicative of cervical myelopathy.

Diagnosing Cervical Myelopathy

It can be difficult to diagnose cervical myelopathy because the symptoms often overlap with other neurodegenerative condition symptoms. 

Your doctor will talk to you and perform a physical examination. Early symptoms may be subtle, but a physical exam can pick up signs of spinal cord dysfunction. Your doctor will order an MRI of your neck to confirm the diagnosis. Though early symptoms are sometimes challenging to identify, Froedtert & MCW specialists have experience diagnosing cervical myelopathy and are aware of the diverse symptoms it can present.

We carefully review the MRI findings in conjunction with clinical symptoms. If there is a mismatch, we will evaluate you for other possible causes prior to recommending surgery. 

Cervical Myelopathy Symptoms

You may or may not experience neck or arm pain. Symptoms may progress slowly or rapidly. Cervical myelopathy symptoms include: 

  • Loss of manual, hand dexterity
  • Alterations in gait or gait impairment when you walk
  • Imbalance, unsteadiness and falls
  • Paraesthesia (tingling or pins and needles sensations)
  • Upper limb weakness, numbness
  • Lower limb stiffness, weakness or sensory loss
  • Limb or body pain on one or both sides
  • Autonomic symptoms, such as bowel or bladder incontinence, erectile dysfunction or difficulty passing urine

Cervical Myelopathy Treatment

Depending on your diagnosis, the most common treatment is surgical decompression followed by post-operative therapy and rehabilitation. We take a thoughtful and nuanced approach to surgical treatment. Many factors go into the decision to proceed with surgery for myelopathy. You need to discuss these factors with your surgeon, but it is important that you have the conversation with your surgeon as soon as possible.

Monitoring

If you have very mild symptoms, we may start by closely monitoring the pressure on your spinal cord. Therapy can help to manage symptoms in some mild cases.

Spinal Cord Decompression Surgery

If surgery is recommended, we will proceed with the least invasive option, trying to preserve motion and decrease recovery time whenever possible. There are several surgical options for relieving the pressure on the spinal cord, such as: 

  • Laminectomy — Removes part of the vertebra where the spinal cord is pinched
  • Laminoplasty — Opens part of the spine vertebra to increase the space in spinal canal and relieve pressure on the spinal cord. 
  • Posterior cervical decompression and fusion — Approaching from the back of the neck, your surgeon decompresses the spinal cord and adds rods and screws for stability and fusion.
  • Anterior cervical diskectomy and fusion — Approaching from the front of the neck, your surgeon removes part or all of a damaged spinal disk to decompress the spinal cord and adds hardware for stability and fusion.
  • Anterior cervical corpectomy and fusion — Approaching from the front of the neck, your surgeon removes damaged vertebra and disk material (the cushion between the vertebra) to relieve pressure on the spinal cord in your neck.

Most patients will stay in the hospital one to three nights after surgery.

After Surgery

Recovery times vary from patient to patient. Symptoms take months to improve in most cases. The most rapid improvements are typically seen in the first three to six months, but patients can typically experience continued improvement over the year following surgery.

In the majority of cases, cervical myelopathy does not come back after surgery and not with the same severity of symptoms you had before. If there is a recurrence of symptoms, it may be due to new spinal cord compression adjacent to the prior surgery. In some cases, an alternate cause — unrelated to the neck — may contribute to recurrent symptoms.

After surgery, the majority of patients improve or, at a minimum, stay the same. Large studies have shown that the prognosis is better for patients who are younger, and those with a shorter duration of symptoms and those who have less disability prior to surgery. That said, the prognosis for each patient is based on their individual clinical situation.

Risk of Leaving Cervical Myelopathy Untreated

If you leave your cervical myelopathy untreated, some patients stay the same, some have rapid decline and others may have a gradual, step-wise decline in function. The timeline for changes in function varies. Decline in function can lead to: 

  • Weakness in the arms and legs
  • Difficulty walking
  • Bladder control issues
  • Paralysis in severe cases 

There are general risks with any surgery, but in the majority of patients the benefits of surgery outweigh the risk.

Post-Surgery Cervical Myelopathy Rehabilitation

The Froedtert & MCW SpineCare Program has a unique Cervical Myelopathy Rehabilitation Program. The program creates a postoperative recovery program tailored to your needs and designed to address your specific myelopathy symptoms. Ultimately, we want you to go back to your life and resume activities you did before you developed cervical myelopathy. These results vary on a patient-by-patient basis.

You will work with your physical therapist to identify issues with strength, range of motion, dexterity and balance — as well as identifying your goals for recovery. We will address any impairments through a variety of exercises while working with physical therapy.

You can expect to be seen for four to six visits over a period of 6 to 8 weeks. This will vary depending on the degree of patient impairment and your goals. 

The Cervical Myelopathy Rehabilitation Program is available on an outpatient basis (no hospital stay required) and is found at our physical therapy locations, pain locations and SpineCare locations throughout southeastern Wisconsin. Call the location to make an appointment.

Cervical Myelopathy Research and a Unique Rehab Program

The Froedtert & MCW Cervical Myelopathy Program is the only center in the world providing cutting-edge research for cervical myelopathy supported by our world-class academic treatment team. We have a strong history of providing care for cervical myelopathy patients — care based on this research. 

The rehabilitation program noted above is a unique and novel rehab pathway for cervical myelopathy patients after surgery