Cervical Myelopathy (Spinal Cord Compression in the Neck)

What Is Cervical Myelopathy?

• Cervical myelopathy occurs when the spinal cord in your neck becomes compressed
• The spinal cord is like a "information highway" carrying signals between your brain and body
• When compressed, these signals don't get through properly, causing loss of function
• Without treatment, symptoms typically get worse over time
• Cervical myelopathy is one of the most common reasons for spinal cord dysfunction in adults over the age of 50.

Common Symptoms

Symptoms usually develop gradually over months or years, although some patients notice a more rapid decline.

Common symptoms include:

• Balance problems – difficulty walking or feeling unsteady, frequent falls, loss of balance
• Hand coordination issues – trouble buttoning clothes, writing, or handling small objects
• Weakness in arms and/or legs
• Numbness / tingling in arms and/or legs
• Bowel or bladder control problems (less common)
• In severe cases – paralysis (inability to walk or use arms)

Important: Neck pain is NOT always present, making this condition easy to miss. Early symptoms are often mistaken for "normal aging."

Not every patient experiences all of these symptoms. A single compressed nerve root causes a different picture — see Cervical Radiculopathy — while myelopathy involves the spinal cord itself.

What Causes Cervical Myelopathy?

The most common cause is age-related wear and tear of the cervical spine.

Why Prompt Treatment Matters

• Myelopathy generally worsens over time – this can happen slowly or rapidly
• You cannot predict if worsening will be fast or slow
• Nerve damage may be permanent – once the spinal cord is injured, surgery may not fully reverse it
• The main goal of treatment is to prevent further damage

How Is It Diagnosed?

Diagnosis begins with a detailed medical history and physical examination.

Your doctor will assess:

• Walking pattern and balance
• Hand coordination and dexterity
• Muscle strength
• Sensation
• Reflexes
• Signs of spinal cord dysfunction

Certain abnormal reflexes may suggest spinal cord compression.

What Tests Are Required?

MRI Scan

MRI is the most important test for diagnosing cervical myelopathy.

It shows:

• Spinal cord compression
• Disc herniations
• Bone spurs
• Narrowing of the spinal canal
• Changes within the spinal cord itself

X-rays

X-rays evaluate spinal alignment and degenerative changes.

CT Scan

A CT scan may provide additional information about bony narrowing.

Nerve Tests (EMG/NCS)

These tests may occasionally be used when symptoms could be related to other nerve conditions.

Treatment Options

Non-Surgical Treatments

• Physical therapy
• Soft collar for short-term immobilization
• Anti-inflammatory medications

These may help with mild symptoms but do NOT stop or slow progression of myelopathy

Surgery – The Only Proven Treatment

• Recommended for patients with significant compression and symptoms
• Primary goal: Remove pressure from the spinal cord and prevent further neurological decline
• Surgery can be done from:
• The front of the neck (anterior approach)
• The back of the neck (posterior approach)
• Both (combined approach) in some cases

What to Expect After Surgery

• Many patients see improvement in some or all symptoms
• Improvement may not be immediate – it can take time
• Some patients may not improve if too much nerve damage already occurred
• Surgery is very successful at stopping further worsening
• Factors affecting recovery:
• How long the spinal cord was compressed
• Severity of the condition
• Overall health (smoking, diabetes, etc.)
• Age

In long-standing cases, surgery may prevent further deterioration rather than completely reverse all symptoms.

Can Cervical Myelopathy Improve Without Surgery?

• Unlike many cases of cervical radiculopathy, cervical myelopathy is usually a progressive condition.
• Once the spinal cord is compressed, symptoms often remain stable or gradually worsen over time.
• Non-surgical treatment may help relieve neck pain but generally does not reverse spinal cord compression.
• Because of this, surgery is frequently recommended when significant spinal cord compression is present.

When Is Watchful Waiting Appropriate?

• Very mild symptoms with mild compression
• Patient has other medical conditions making surgery too risky

What Happens If Cervical Myelopathy Is Left Untreated?

Without treatment, some patients may experience:

• Progressive difficulty walking
• Increasing balance problems
• Worsening hand function
• Weakness in the arms or legs
• Loss of independence in daily activities

Severe untreated cases can result in significant neurological disability.

Key Takeaway

If you have symptoms of cervical myelopathy, see a fellowship-trained spine surgeon promptly. Early evaluation and treatment offer the best chance to prevent permanent nerve damage.

Surgical Treatment Options

The choice of surgery depends on the location of compression, spinal alignment, the number of affected levels, and individual patient factors.

1. Anterior Cervical Discectomy and Fusion (ACDF)

The damaged disc is removed through a small incision in the front of the neck, relieving pressure on the spinal cord and nerves.

2. Cervical Corpectomy

In some cases, part of a vertebral body must be removed to adequately decompress the spinal cord.

3. Posterior Cervical Laminectomy

The back part of the vertebra is removed to create more space for the spinal cord.

4. Laminectomy with Fusion

When additional stability is required, decompression may be combined with spinal fusion.

5. Laminoplasty

In selected patients, the spinal canal can be expanded while preserving motion.

Your surgeon will recommend the procedure best suited to your specific condition.

Frequently Asked Questions

Is cervical myelopathy the same as a pinched nerve?

No.

A pinched nerve (radiculopathy) affects a single nerve root. Cervical myelopathy involves compression of the spinal cord itself.

Can physiotherapy cure cervical myelopathy?

Physiotherapy may help maintain mobility and strength, but it cannot remove spinal cord compression.

Is surgery always necessary?

Not always. Mild cases may be monitored closely. However, surgery is commonly recommended when there is evidence of spinal cord dysfunction or progressive symptoms.

Will surgery restore normal function?

Many patients improve after surgery, but the degree of recovery varies. Earlier treatment generally offers the best chance of neurological improvement.

Is cervical myelopathy an emergency?

Most cases develop gradually. However, rapidly worsening weakness, severe difficulty walking, or sudden neurological decline requires urgent medical evaluation.

When Should You Seek Medical Attention?

Consult a spine specialist if you experience:

• Increasing difficulty with balance or walking
• Hand clumsiness
• Progressive weakness
• Frequent falls
• Loss of coordination
• Persistent numbness in the hands

Early diagnosis and treatment can help prevent permanent spinal cord injury.

Related Conditions

See also Cervical Spinal Stenosis, the structural narrowing that can lead to myelopathy, and Neck Pain for the full range of causes.

About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. Learn more about Dr. Chaudhary →

This information is for general education and does not replace a consultation with your doctor.