Overview
Cervical myelopathy occurs when the spinal cord in the neck becomes compressed, impacting its function. The most common cause is degenerative change due to age. This includes wear and tear of discs, bones, and ligaments, leading to a narrowed spinal canal. Other causes include disc herniation, ossification of the ligaments, rheumatoid disease, trauma, tumours, and congenital narrowing or spinal deformity in younger individuals.
Surgery for cervical myelopathy is a decompressive procedure aimed at creating more space for the spinal cord. This reduces the risk of further injury and may allow some recovery of function in many patients.
Unlike most neck problems, myelopathy is not primarily a pain condition. Mild to moderate cervical myelopathy with stable symptoms can often be managed conservatively with observation, regular clinical monitoring, and specialist review. While physiotherapy, medication, and injections can help manage associated symptoms, they do not resolve structural spinal canal narrowing. For patients where the spinal cord is under sustained pressure, or in cases that are moderate, severe, or progressing, surgery for cervical myelopathy is currently the only treatment that effectively decompresses the cord and halts neurological decline.
The specific operation used depends on the location of the compression, the number of levels affected, the alignment of the neck, and the patient’s overall health. Surgical options include anterior cervical discectomy and fusion, anterior corpectomy and reconstruction, posterior laminectomy with or without fusion, and laminoplasty, which reshapes and expands the canal without complete bone removal.
Who is it for?
Cervical myelopathy develops slowly, often leading to early symptoms that may be confused with normal ageing. You should seek a specialist assessment if you notice:
- Increasing clumsiness in the hands, difficulty with buttons, keys, or handwriting.
- Numbness, pins and needles, or a burning sensation in the hands or arms.
- Weakness or loss of grip strength.
- Unsteadiness when walking, wide-based gait, or frequent stumbles and falls.
- A feeling of heaviness or stiffness in the legs.
- Neck stiffness, sometimes with pain radiating into the shoulder or arm.
- Electric shock sensations down the spine when bending the neck forward.
- New problems with bladder urgency or control.
Surgery may be recommended if examination and imaging confirm cord compression associated with your symptoms. This is especially true for patients with moderate, severe, or progressing symptoms. Those with mild, stable signs may be monitored with regular reviews initially.
How treatment works
Assessment
Your symptoms, examination and scans confirm whether the spinal cord is compressed and if surgery is appropriate.
Planning
The surgical approach is chosen based on the location of compression, spinal alignment and the number of levels affected.
Decompression Surgery
Pressure is removed from the spinal cord using the most appropriate procedure. Fusion or stabilisation may be performed if required.
Recovery
Most patients begin walking within a day, with neurological recovery continuing over the following months.
Risks and Honest Expectations
Cervical myelopathy surgery carries risks including infection, bleeding, swallowing difficulties, hoarseness, cerebrospinal fluid leak, nerve injury, implant or fusion problems, blood clots, and the general risks associated with anaesthesia. Some patients may require further surgery.
The main aim is to prevent further spinal cord damage rather than restore normal function. Some patients experience significant improvement, while others achieve stabilisation of symptoms. Recovery varies, and neurological improvement may continue for 3–6 months.
Where compression is mild and symptoms are stable, monitoring and non-surgical care may be appropriate. If myelopathy progresses, surgery is often recommended sooner rather than later, as non-surgical treatment cannot widen a narrowed spinal canal.
QUICK FACTS
Procedure time
2–4 hours
Anaesthetic
General
Hospital stay
1–2 nights
Mobilising
Same day or next day
Recovery
3–6 months