Chronic Neck Pain? It Could be Cervical Spondylotic Myelopathy
Have you ever heard of something called a cervical spondylotic myelopathy? I know very long medical terminology, but there are times when what you think is a simple trapped nerve in your arm could be more a chronic problem with your neck. I’ll explain what I mean below.
Most of the time it is just a case of the neck joints or neck muscles being tight, however, there might also be a localised herniated disc in your neck. If you have seen on a x-ray chronic wear and tear changes in your cervical spine then you could potentially get a problem called cervical spondylotic myelopathy (CSM). That is why in today’s article I want to try help you understand a bit more about what this type of chronic neck pain and stiffness condition is all about, its symptoms, the common causes and how to treat the resultant nerve damage.
Table of Contents
Cervical Spondylotic Myelopathy
Let me first break down this medical diagnosis into plain English. Cervical means the neck bones. Then there is spondylosis which means arthritis in the neck and myelopathy means a disturbance to the spinal cord. Basically a cervical spondylotic myelopathy means a neck degeneration problem causing a disturbance to the spinal cord.
The spinal cord compression can come from:
- An acute injury e.g. like a car accident or infection,
- Chronic neck degeneration e.g. poor posture, previous whiplash.
Most people diagnosed with cervical spondylotic myelopathy have had a long-term wear and tear problem in their neck. The neck joint and disc degeneration could be causing what is called spinal stenosis, a herniated cervical disc or both.
CSM is classified as the degenerative form of a cervical myelopathy.
Cervical Spondylotic Myelopathy Video
In the following video you will see a patient who has degeneration of their cervical spine from levels C4-5-6-7. This patient has signs of spinal cord compression at around the C6-7 disc level.
So Who Gets a Cervical Myelopathy?
As I mentioned earlier people, who have had prolonged, chronic degeneration of their spine are more likely to get a cervical spondylotic myelopathy, just like the patient in the above video example.
This means if you have:
- Severe degenerative disc disease,
- A herniated cervical disc,
- Cervical spondylosis from osteoarthritis or other types arthritis.
Then it is possible to develop a case of cervical myelopathy. This condition tends to happen in the more elderly population because they have lived long enough for spinal structures to slowly degenerate.
The symptoms of a cervical spondylotic myelopathy can at first look like a basic pinched nerve. However, if there are other problems like these then the spinal cord could be involved:
- Pins and needles, numbness in your legs or arms,
- Weakness in your legs or arms,
- Spasticity in your legs causing walking difficulties,
- Bladder changes (incontinence).
When your spinal cord is being pinched this is what something a UK neurologist would say is a mixture of a upper motor neuron lesion and a lower motor neuron lesion. This means for your understanding that the symptoms in the arms are different to the symptoms in the legs, but that both can be involved.
How To Test for CSM
If you show up at your GP surgery with a general neck ache or a pinched nerve n your arm pain then they should do a neurological screening of you. This means basic muscle reflex testing, muscle strength testing and sensation testing for sharp and soft feeling.
Further questioning by your doctor on your health history might make them lean towards the diagnosis of a cervical myelopathy.
Special diagnostic tests can include:
It all depends what your doctor thinks is causing the spinal cord compression. The question is the spinal cord compression from the outside or from within.
How To Treat CSM
To treat a cervical spondylotic myelopathy depends again on what is causing the spinal cord compression.
If the spinal cord is being compressed from the outside due to spinal degeneration then spinal surgery is likely. The quicker the pressure can come off the spinal cord then the less chance of long term damage to the nerve signals. This typically is the case for a cervical spondylotic myelopathy.
So someone might start off with a cervical disc that is causing just a arm pain, pins and needles or weakness. Typically conservative treatment is the route to start of with this.
However if they notice changes in their legs or bladder over time then that disc is causing more then a localised cervical radiculopathy problem. This needs to be seen to by a neurologist, neurosurgeon or orthopaedic surgeon with an interest in spinal conditions.