Myelopathy

Myelopathy is a term that means that there is something wrong with the spinal cord itself. This process does not commonly occur with low back pain because the spinal cord itself ends at about the level of the first and second lumbar vertebral body. From this point on, only nerve roots occupy the spinal canal. However, in certain situations where there is extensive arthritis and stenosis in the upper parts of the lumbar spine, or elsewhere in the cervical and thoracic spine, a patient may develop myelopathy as a result of compression of the spinal cord. This disease is often first detected as difficulty walking due to generalized weakness or problems with balance and coordination.

Myelopathy is most commonly caused by spinal stenosis, which is a progressive narrowing of the spinal canal. In the later stages of spinal degeneration, bone spurs and arthritic changes make the space available for the spinal cord within the spinal canal much smaller. The bone spurs may begin to press on the spinal cord and the nerve roots, and that pressure starts to interfere with how the nerves function normally. Myelopathy is the gradual loss of nerve function caused by disorders of the spine. Myelopathy can be directly caused by spinal injury resulting in either reduced sensation or paralysis. Degenerative disease may also cause this condition, with varied degrees of loss in sensation and movement. When a nerve in the spinal cord is pinched causing extreme pain, the condition is called myelopathy.

Definition: Myelopathy is a term used to refer to any condition that creates problems in the spinal cord. The term myelopathy literally means "sick spinal cord" or "disease of the spinal cord". When the spinal cord is affected by conditions of the vertebral bones and/or intervertebral disks, such as in cases of cervical spondylosis, this is myelopathy.

Myelopathy is a complex diagnostic problem with many possible causes. Diagnosis rests on recognition of a constellation of symptoms consistent with central nervous system pathology involving trunk, arms, and legs and, in general, sparing the head. Symptoms of cerebral and neuromuscular disease may mimic myelopathy and require brain imaging or electromyography. Pain, most commonly over the site of the lesion, is one of the cardinal complaints of patients with spinal cord disease. Complaints of motor abnormalities caused by myelopathy may include sudden weakness and paralysis, clumsiness, fatigability; sensory complaints such as paresthesias, numbness, deadness, dysesthesias, and bladder symptoms are also characteristic. General examination may point to systemic disease associated with myelopathy. Neurological examination excludes cerebral disease. Motor and sensory examination may define the level of the lesion. Physical examination localizes not only the level of the spinal cord lesion but the anatomic distribution of the lesion within a given level. When tumor or paraspinal infection are diagnostic possibilities, emergent imaging of the spine is required.



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