MYELOPATHY

Types of myelopathy depends on the cause. Some of the types are:

• Spinal cord injury (due to trauma)
• Myelitis (due to inflammatory)
• Vascular Myelopathy (due to vascular diseases)

Clinical signs and symptoms depend on which spinal cord level (cervical, thoracic or lumbar) is affected and the extent (anterior, posterior or lateral) of the pathology. It may include:

• Upper Motor Neuron Signs—weakness, spasticity, clumsiness, altered tonus, hyperreflexia and pathological reflexes, including Hoffmann’s sign and inverted Plantar reflex (positive Babinski sign);
• Lower Motor Neuron Signs—weakness, clumsiness in the muscle group innervated at the level of spinal cord compromise, muscle atrophy, hyporeflexia, muscle hypotonicity or flaccidity, fasciculations;
• Sensory Deficits
• Bowel/Bladder Symptoms and Sexual Dysfunction

Diagnosis

Clinical exam findings primarily diagnosed Myelopathy. Diagnosis of this clinical syndrome is extensive since it can be caused by many pathologies. Once it is established, the underlying cause needs to be investigated. This may involve medical imaging techniques such as:

• Magnetic Resonance Imaging (MRI) – Commonly used for routine diagnosis.
• X-Rays – To detect arthritic changes of the bones.
• Computer Tomography – Often used for pre-operative planning of surgical interventions for cervical spondylotic myelopathy
• Angiography – Used to examine blood vessels in suspected cases of vascular myelopathy

The presence and severity of myelopathy can also be evaluated by means of Transcranial Magnetic Stimulation (TMS). It is a neurophysiological method that allows the measurement of the time required for a neural impulse to cross the pyramidal tracts, starting from the cerebral cortex and ending at the anterior horn cells of the cervical, thoracic or lumbar spinal cord. This measurement is called Central Conduction Time (CCT).

TMS can aid physicians to:

• Determine whether myelopathy exists
• Identify the level of the spinal cord where myelopathy is located. This is especially useful in cases where more than two lesions may be responsible for the clinical symptoms and signs, such as in patients with two or more cervical disc hernias
• Follow-up the progression of myelopathy in time, for example before and after cervical spine surgery

TMS can also help in the differential diagnosis of different causes of pyramidal tract damage.

Treatment

The treatment and prognosis of myelopathy depends on the underlying cause. For example, myelopathy caused by infection requires medical treatment with pathogen specific antibiotics. Similarly, specific treatments exist for multiple sclerosis, which may also present with myelopathy. As outlined above, the most common form of myelopathy is secondary to degeneration of the cervical spine. Newer findings have challenged the existing controversy with respect to surgery for cervical spondylotic myelopathy by demonstrating that patients benefit from surgery.