Spondylotic Cervical Myelopathy

What it is

This is compression of the spinal cord in the neck caused by the wear-and-tear changes of aging — bone spurs, bulging discs, and thickened ligaments that gradually narrow the canal the cord runs through. Unlike a pinched nerve, which affects one arm, pressure on the cord itself can affect the hands, the legs, balance, and coordination. It is the most common cause of spinal cord dysfunction in adults over 55.

What it feels like

The symptoms are often subtle at first and easy to dismiss: clumsy hands (trouble with buttons, zippers, or handwriting), dropping things, a feeling of imbalance or a heavier, less sure gait, and numbness or tingling in the hands. Neck pain may be mild or absent, which is part of why this condition is often present for a while before it is recognized.

How we diagnose it

A careful neurological exam looks for the specific signs of cord involvement, and an MRI shows where and how severely the cord is being compressed. I put the exam and the MRI together, because the goal is to catch cord trouble before it advances.

How we treat it

Myelopathy is the one neck condition where I am less inclined to simply wait. Mild, stable cases can be watched closely. But when there are clear signs of cord involvement — or they are progressing — surgery to take pressure off the cord is usually recommended, and recommended earlier rather than later. The operation may be done from the front, the back, or both, sometimes with a fusion and sometimes with a motion-preserving option such as laminoplasty, depending on your anatomy.

The science — for the curious

The reason I treat myelopathy differently from a pinched nerve is that the spinal cord does not bounce back the way a nerve root does. Function that is lost to cord compression often does not fully return, so the main aim of surgery is to halt the decline and protect what you still have, rather than to wait for improvement that may not come. That is why timing matters here: decompressing before the cord is badly affected gives the best result.

Learn more

OrthoInfo — Cervical Spondylotic Myelopathy: orthoinfo.aaos.org

North American Spine Society — Cervical Stenosis & Myelopathy: spine.org / KnowYourBack

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.