03 Oct Cervical Myelopathy: Options for Surgical Treatment
Myelopathy is a collective term used to describe the different problems involving the spinal cord – specifically, a nervous system disorder affecting the spinal cord.
Types of Myelopathy
The different types of myelopathy include:
- Thoracic myelopathy – a nervous system disorder which affects the middle of the spinal cord (the thoracic)
- Cervical myelopathy – compression of the spinal cord in the neck
- Lumbar myelopathy – a nervous system disorder which affects the lower part of the spinal cord (the lumbar)
Best Candidates for Cervical Myelopathy Surgery
Those suffering from cervical myelopathy might experience progressive neurological changes which include:
- Gait changes
- Difficulty with fine motor skills
- Weakness experienced in the legs or arms
- Hand numbness
- Issues with imbalance
Of those who suffer from the above symptoms, the patients who see the best results from surgery options include those:
- With a shorter period of symptoms
- At a younger age
- With a larger available spinal cord area
- With single areas of spinal cord involvement – rather than multiple
Types of Surgical Procedures
Surgical procedures options for the treatment of cervical myelopathy include:
- Anterior Cervical Corpectomy and Fusion
- Anterior Cervical Diskectomy and Fusion
During a laminoplasty – an alternative to a laminectomy – the lamina is cut on one side and thinned out on the other creating a “hinge.” The hinge-like structure created during the procedure is used to open up the bony area and expand the available space which will be used for the spinal cord.
While this does open up more space, it does not guarantee the spinal canal will be completely open for the spinal cord. Another possible disadvantage to the laminoplasty is that the hinge created, in some cases, could end up closing.
During a laminectomy, the surgeon will remove the bony arch forming the backside of the spinal canal. In addition, any ligaments or bone spurs that are compressing on the spinal cord will also be removed. By providing the spinal cord extra space to drift backward, the procedure relieves some pressure.
The purpose of a fusion is to eliminate the movement between the vertebrae – which have deteriorated – and to also eliminate some of the flexibility of the spinal cord. The degree of limitation will be determined by the number of vertebrae fused – the idea behind it says if the spine segments are immobile, they should no longer cause pain. During all fusions, bone material (bone graft) is used to aid in the fusion. Sometimes, some doctors might also place a synthetic “cage” – known as a spacer – between the vertebrae. The spacer contains the bone graft allowing the fusion to take place.
While each approach can stand on its own, some patients do require a combined approach for better results. Patients who might require a combined approach to cervical myelopathy surgery include those who have:
- Weakened bone as a result of severe osteoporosis
- Kyphosis – fixed or severe
- Multiple levels of involvement which require supplemental stabilization
The advantages to surgery include spine stabilization, neck pain relief, the removal of the structures causing problems and pain, and more.