Wear or disc herniations to the cervical spine can lead to degenerative limitations of the spinal cord with neurological deficits. Doctors speak of a myelopathy.

What is myelopathy?

The medical term myelopathy or cervical myelopathy is composed of the Greek words "myelon" = spinal cord and "pathos" = pain and stands for damage to the spinal cord in the area of ​​the spine. Damage to the spinal cord can lead to a number of ailments such as gait insecurity, numbness and other neurological problems. Most commonly, the cervical spine is affected, but myelopathy can also occur elsewhere in the spine.

causes

The main cause of myelopathy lies in a constriction of spinal cord, which may be congenital, but is acquired in most cases during life. The degenerative changes that lead to myelopathy can be traumatic and can be triggered by accidents or falls, but they can also be caused by inflammation, tumors or changes after surgery such as scarring.

In most cases, myelopathy is triggered by degenerative changes and signs of wear in the affected area of ​​the spine. They tighten the spinal cord and irritate the nerve roots. Also, different types of herniated discs can lead to stenosis of the spinal cord.

Symptoms, complaints & signs

Typical symptoms of myelopathy include neck pain that spreads to the arms, and sometimes also numbness and a feeling of weakness in the arms. Arms and hands can fall asleep at night. A first sign may be a neck stiffness and a limited turning ability of the head to the left or right.

If the spinal cord is already damaged, the discomfort may also radiate to the legs, causing uncertainty in walking and impairment of the bladder and bowel. An important feature is the feeling of an electric shock that can occur when bending the head (Lhermittsches sign). The further the disease has progressed, the more neurological deficits can occur. These include ants running, tingling, pain, tapping, problems with coordination, and problems with everyday activities such as tying shoes or putting on a jacket. In severe cases, it can lead to paralysis, bladder, bowel and potency disorders.

Diagnosis & disease course

The most important option for diagnosing myelopathy is magnetic resonance imaging (MRI). It is most markedly degenerative with pressure on the spinal cord. When extensive ossification needs to be treated, computed tomography (CT) is an indispensable bone imaging tool to better plan and assess the surgical procedure.

In order to prevent an unfavorable course in time, the earliest possible diagnosis is important. In patients with acute discomfort following a herniated disc, the chance of the symptoms resolving is greatest if the herniated disc is promptly diagnosed. Bone changes can be slow and insidious and sometimes are not immediately noticed or associated with other problems.

Magnetic resonance tomography reveals degenerative changes in the cervical spine with changes in the neck spinal cord. The treatment of myelopathy depends on the extent of the injury.

complications

Myelopathy causes severe neurological deficits in the patient. These failures can thus lead to paralysis and further disturbances of the sensitivity and thus significantly limit the quality of life of the patient. Movement restrictions continue to occur so patients may need other people's help in their everyday lives. The affected suffer mainly from severe pain in the neck and on a stiff neck.

This is the turning of the head associated with pain. There are also problems with coordination and concentration. The pain can limit everyday life and in the form of rest pain can also lead to sleep problems at night. Not infrequently, myelopathy also leads to potency problems.

Likewise, bowel and bladder are affected by the disease. Patients often develop mental health problems. The basic disease may also limit the life expectancy of the person affected by myelopathy. In many cases, the damage is irreversible, so no treatment can take place.

By various therapies, however, the complaints can be alleviated. However, a complete cure of myelopathy does not occur in most cases. Other complications usually do not occur during treatment.

When should you go to the doctor?

Pain in the back or cervical spine should always be medically clarified. If the symptoms have persisted for a long time and become more severe over time, it may well be due to a serious condition such as myelopathy, which needs to be medically diagnosed and treated therapeutically. Affected persons consult best the family doctor. This can make a first diagnosis and refer the patient to an orthopedist if necessary.

The actual treatment is done by various specialists and a physiotherapist. Depending on the severity of the disease, surgical measures must also be taken. People who already have back problems are at particular risk of developing myelopathy. Older people and people with spinal or spinal malformations are also at risk and should talk to a doctor at an early stage. The therapy is tedious and the patient has to be examined regularly, so that complications can be excluded and, if necessary, treated directly. In addition, a regular adjustment of the medication is necessary.

Treatment & Therapy

In most cases, conservative treatment does not help sufficiently because it does not eliminate the cause, the spinal cord squeeze. Squeezes of the spinal cord and changes to the bones usually can not regress on their own. A herniated disc can regress and does not always have to be operated on, but it takes a lot of time.

If the incident has caused spinal cord injury, surgery is required because otherwise the symptoms will not disappear. Conservative therapy may sometimes be necessary if patients can not be operated because of their increased age or comorbidities. It includes the administration of analgesic, decongestant and anti-inflammatory drugs. If necessary, a neck brace and bed rest must be prescribed.

When there is no pain, physiotherapy helps to stabilize the cervical spine. During conservative treatment, follow-up should be closely monitored to quickly detect possible worsening. When it comes to neurological impairments or failures, an operation to relieve the spinal cord is inevitable. The procedure must always be performed inpatient, with infusions or medication before the operation to induce swelling of the spinal cord.

During anesthesia care must be taken to avoid hyperextension of the head when the patient is being stored in order not to squeeze the spinal cord any more. Mostly, the operation is done from the front, with appropriate findings but also from the back. After the operation, decongestants continue to be required for several days. Subsequently, a rehabilitation procedure is usually followed with exercises to reduce the symptoms. Often they can not be healed completely.

Outlook & Forecast

The prospects of myelopathy are mixed. Basically, the best chances of recovery are an early diagnosis and a subsequent start of therapy. In practice, however, it usually turns out to be problematic that the disease progresses creepingly. There are no adequate early detection signals. As a result, neurological deficits and changes in the bones can no longer be corrected. Doctors often talk about a treachery of myelopathy. The quality of life suffers. The progressive course leads to ever greater complaints if it is not treated.

The acute myelopathy usually brings the chance that the symptoms completely regress. The medical expenses are low, depending on the patient's initial condition. If tumors or other diseases trigger myelopathy, the success of treatment depends crucially on combating these causes.

Usually after a surgery a rehabilitation lasting several weeks follows. If necessary, stress restrictions must be accepted in everyday life. Back-friendly behavior and strengthening of the musculature are indispensable. Some patients may need relieving aids for the rest of their lives if they are severely affected. If necessary, a permanent care is necessary.

prevention

Myelopathy, as with most spinal diseases, can be effectively prevented by avoiding one-sided movements and chronic malpractices. People who work in the office and have to sit a lot at their desks and computers should do regular cervical spine exercises.

Regular physical exercise strengthens the back muscles and improves back pain. In case of mild discomfort, physiotherapy exercises help to prevent chronic malpractices and to relieve the spine.

aftercare

In most cases, patients with myelopathy have very limited and very few immediate follow-up measures available. The person concerned should therefore consult a doctor at an early stage, so that no other complications and complaints occur. The sooner a doctor is visited, the better is usually the further course of the disease.

In the event of having a child, the person concerned should first consider genetic testing and counseling to prevent the disease from reoccurring in the children. Most sufferers are dependent on the measures of physiotherapy or physiotherapy in myelopathy. Many of the exercises can be done in your own home.

Many sufferers are dependent on the intake of various medications. The affected person should always rely on a correct dosage and also on a regular intake. In case of ambiguity or questions, the person concerned should always contact a doctor first to avert possible complications and complaints in advance.

You can do that yourself

Which measures myelopathy patients can take in everyday life depends on the cause and severity of the disease. If only a herniated disc is the cause, the complaints can be alleviated by professionally guided physiotherapy. The patient can support home therapy through individual exercises. Moderate movement helps to prevent the disc from slipping out again.

If an operation is necessary, the person concerned needs first and foremost protection. The procedure is usually a great burden on the spine, which is why in the first day after the operation should be dispensed with strenuous physical activities. If necessary, the patient must wear a neck brace and walk with crutches at the beginning. If pain occurs, a relatively strong analgesic must be used to avoid malpractices and resulting damage. The patient can support the medication by various means of naturopathy. In addition to valerian drops, preparations such as arnica or devil's claw have also proved their worth. For acute pain, a hot bath helps.

In parallel with these measures, a doctor must monitor the course of the disease. If complications arise, the physician must be informed. Myelopathy may be due to a tumor disease or inflammation that needs to be treated first.

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