Cervical Myelopathy

Specialty Area: Spine Center

Causes
Cervical myelopathy is a constellation of symptoms. Many different disease processes can cause this disorder:

• Tumors within the spinal cord
• Extrinsic tumors compressing the spinal cord
• Vascular malformations
• Neurologic disease (such as transverse myelitis)
• Extrinsic compression on the spinal cord from spondylosis, degenerative arthritis and rheumatoid arthritis.

Proper diagnosis of the cause of the myelopathy dictates the treatment of the disease.

Symptoms
In addition to the cause of cervical myelopathy, there are a broad range of symptoms. In a mild form, only subtle signs will be evident. In more severe cases, patients may describe:

• Difficulty with fine motor control, such as buttoning a shirt, writing or typing
• Difficulty with balance
• Trouble moving from place to place
• Trouble with breathing
• Paralysis of the lower half of the body, or even paralysis in all four limbs.

Oftentimes, treating the cause of the myelopathy can significantly improve and preserve quality of life.

Hopkins Treatment
Cervical myelopathy caused by spinal cord compression from spondylosis, degenerative arthritis and rheumatoid arthritis requires individualized, unique treatment plans based on the patient’s pathology reports. The Spine Center at Johns Hopkins has refined surgical procedures to address these problems and continues to develop new techniques. Available procedures involve both decompressive strategies and if needed, complex spinal reconstruction.

Some of the surgical approaches and stabilization procedures available include:

• Anterior cervical discectomy (surgical removal of a disk) and fusion
• Anterior cervical corpectomy (surgical removal of the affected vertebral body and disks on either end) and fusion
• Cervical laminectomy (surgical removal of the posterior arch of the vertebra)
• Multilevel cervical laminectomy
• Cervical laminoplasty
• Cervical laminectomy and fusion
• Transoral decompression
• Transmandibular vertebrectomy and reconstruction
• Occipital cervical fusion
• Cervico-thoracic fusion
• Occipital-cervical-thoracic fusion

To ensure an optimal result after a decompression has been performed, we work closely with physical therapy, occupational therapy and physical medicine and rehabilitation to optimize a patient's outcome.