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Cervical Myelopathy – Cervical Discectomy
Cervical Spondylodesis – Myelopathy
Many patients experience neck pain, shoulder pain, arm pain, or pain between the shoulder blades, which can be caused by abnormalities or disorders of the cervical spine. These symptoms are often due to herniated discs or cervical arthritis.
The cervical spine consists of vertebrae and intervertebral discs, which allow for neck movement while also absorbing shock and bearing weight.
Degeneration in the cervical spine is called cervical spondylosis. Similar to the lumbar spine, over time the intervertebral discs degenerate, causing neck pain, a condition known as discopathy (or degenerative disc disease). Some of these discs, as they degenerate, may herniate—meaning the annulus fibrosus (outer ring) ruptures and the nucleus pulposus (the inner gel-like core) protrudes into the spinal canal, compressing the spinal cord or nerve roots. This results in nerve-related symptoms.
Disc herniation usually occurs suddenly, with acute symptoms. In older individuals, degeneration is more often associated with the formation of osteophytes (bone spurs) rather than herniated discs. When both the nerve roots and the spinal cord are compressed, symptoms from spinal cord dysfunction (not pain) appear—a condition known as myelopathy.
What are the main symptoms?
The final result is a gradual narrowing of the cervical spinal canal and compression of the spinal cord and nerves.
- Arthritis (cervical spondylosis)causes neck pain that may radiate between the shoulder blades.
- Nerve root compressioncauses pain, weakness, or numbness in the arm.
- Spinal cord compression (myelopathy)leads to:
- Difficulty walking (not dizziness).
- Difficulty with fine motor skills(e.g., buttoning clothes, writing).
Is there a conservative treatment to avoid surgery?
As with lower back issues, most patients with cervical symptoms such as localized pain or radiating arm pain do not require surgery. They typically improve with conservative treatment, which includes:
- Anti-inflammatory medications,
- Physiotherapy, and
- Application of heat and cold therapy.
About 90% of patients experience pain relief within 2 to 4 weeks.
Surgery: Anterior Cervical Discectomy & Fusion (ACDF)
If a patient continues to experience significant neck or arm symptoms (such as radiating pain) despite conservative treatment, they may be a candidate for surgery. Persistent weakness that does not improve is also an important reason for surgical intervention.
Myelopathy is an absolute indication for surgery, regardless of age, because it always progresses, even slowly, and can lead to spasticity, walking difficulties, and loss of independence.
What is ACDF?
Anterior Cervical Discectomy and Fusion (ACDF) is the most common surgical procedure for treating symptoms caused by cervical disc degeneration or herniation.
In this procedure, the entire degenerative disc is removed and replaced with a cage (spacer) filled with bone graft (either from the patient or from a bone bank).
This fusion is usually stabilized with a metal plate.
The goals of the surgery are:
- To remove the disc and any osteophytescompressing the spinal cord or nerves.
- To stabilize the spinal segmentusing the bone graft and metal plate, thereby reducing pain related to movement at that level.
This surgery improves pain and strength almost immediately in the majority of patients.
It can also be performed at multiple levels of the cervical spine if necessary.
Serious complications are rare.
Most patients may experience mild difficulty swallowing for 1–2 days.
Even fusion failure, which is rare, is not always symptomatic and may not cause any issues for the patient.
Frequently Asked Questions about Myelopathy
What is myelopathy?
Myelopathy is damage to or dysfunction of the spinal cord caused by pressure inside the spinal canal. In the neck, it usually appears because of degenerative changes (disc disease, arthritis, bone spurs).
What are the symptoms of myelopathy?
The main symptoms are difficulty walking, weakness or stiffness in the legs, and difficulty with fine hand movements (for example writing or buttoning). Pain is a rare symptom.
What causes cervical myelopathy?
The most common cause is degeneration of the cervical spine (disc disease, bone spurs). Less often, it may be caused by injury, tumors or other conditions.
How is cervical myelopathy diagnosed?
The diagnosis is based on the doctor’s clinical examination (neurological signs) and on imaging tests, mainly an MRI of the neck.
Is there conservative treatment for cervical myelopathy?
Mainly a cervical collar while waiting for surgery. When the spinal cord is under pressure, surgery is the main treatment.
How is cervical myelopathy treated?
Surgical decompression with anterior cervical discectomy and fusion (ACDF) is the most common procedure. Its goal is to remove the pressure on the spinal cord and stabilize the spine. Other options are laminoplasty or laminectomy, which are posterior procedures, depending on the patient’s age and needs.
What should I expect after surgery for cervical myelopathy?
Most patients see an improvement in the control of their movement (walking and fine hand movements) very soon after surgery. Numbness takes months to go away. Neck mobility remains good, and recovery includes physiotherapy and a gradual return to daily activities.