health of the nervous system

Cervical myelopathy of A.Griguolo

Generality

Cervical myelopathy is the medical term that indicates any pathology of the very first part of the spinal cord, that is, with a course along the neck area.

More specifically, they are cervical myelopathies: cervical spinal stenosis, cervical myelitis, all cervical spinal cord injuries of traumatic origin and blood vessel diseases that nourish the cervical spinal cord.

Cervical myelopathy can be associated with numerous symptoms, including neck pain, shoulder pain, loss of fine motor skills, limb muscle weakness and paraesthesia.

The cause and severity of the symptoms influence the choice of therapy adopted in the presence of a cervical myelopathy.

Brief review of the Spinal Cord

The spinal cord is, together with the brain, one of the two fundamental components of the central nervous system .

Structurally very complex, this vital nervous organ has several groups of neurons (arranged in white and gray matter ) and 31 pairs of nerves (the so-called spinal nerves ), and covers the important task of sorting incoming and outgoing signals between the different brain areas ( lobes of the brain, cerebellum, etc.) and the rest of the organism.

The spinal cord takes place, in order to receive protection, inside the so-called spinal canal, ie the conduit resulting from the overlapping of vertebral vertebral column and their characteristic holes.

What is a Cervical Myelopathy?

Cervical myelopathy is the medical term that indicates any disease or suffering of the spinal cord tract enclosed within the first 7 vertebrae of the vertebral column (cervical vertebrae).

Cervical myelopathies: what are they in the details?

In the list of cervical myelopathies, there are: episodes of cervical spinal stenosis, forms of myelitis (ie inflammation of the spinal cord) with cervical site, lesions of the cervical spinal cord of traumatic origin (cervical spinal lesions or cervical myelic lesions) ) and vascular diseases related to the cervical spinal cord ( cervical vascular myelopathies ).

Cervical vertebrae.

What is the most common Cervical Myelopathy?

The most common and (precisely because it is common) interesting cervical myelopathy is cervical spinal stenosis.

Cervical spinal stenosis is a pathology of the complex "cervical spine - cervical spinal cord", characterized by the narrowing of the spinal canal and, consequently, by an acute or chronic compression (depending on the causes) of the spinal cord .

Origin of the name

  • The term "myelopathy" derives from the union between the word "honey", which in medicine refers to the spinal cord, and the word "patia", which means "disease".
  • The term "cervical", on the other hand, refers to the region of the neck, ie the anatomical section of the human body along which the cervical tract of the vertebral column and spinal cord pass (NB: "cervical" may also refer to the cervix; however, it is unlikely to be confused, as the context always and immediately clarifies the precise area of ​​discussion).

From this etymological analysis it appears that the literal meaning of "cervical myelopathy" is "cervical spinal cord disease".

Causes

In this chapter dedicated to the causes of cervical myelopathy, the reader will be able to investigate the causative factors of cervical spinal stenosis, cervical myelitis, cervical spinal lesions and cervical vascular myelopathies, ascertaining, at the conclusion of all, that the picture of suffering of the cervical spinal cord is much more complex than it appears.

Cervical Spinal Stenosis

The causes of cervical spinal stenosis include:

  • Cervical spondylosis . Spondylosis corresponds to osteoarthritis of the spine; consequently, cervical spondylosis is the osteoarthritis of the cervical tract of the spine.

    The clinical peculiarity of this widespread medical condition is the gradual degeneration of the cervical vertebrae (due to the precision of the bodies of these vertebrae), a degeneration that alters the morphology of the cervical spinal canal (ie the spinal canal of the cervical spine).

    Favored by factors such as advanced age, obesity and a history of neck trauma, cervical spondylosis is the main cause of cervical spinal stenosis.

  • Cervical spinal tumors . They are clusters of abnormal cells ("crazy" cells) located in the cervical spine.

    Cervical spinal tumors (and spinal tumors in general) cause spinal stenosis, because, with their mass (which is constantly increasing due to the hyperproliferation typical of neoplastic processes), they subtract the space assigned to it from the spinal cord.

  • Rheumatoid arthritis . It is a degenerative joint disease, which, when it affects the cervical spine, has effects similar to cervical spondylosis.

    According to the reliable opinion of the doctors, rheumatoid arthritis would be an autoimmune disease.

  • Hernia of the cervical disc (or cervical hernia ). In medicine, the term "herniated cervical disc" indicates the exit of the nucleus pulposus of one of the cervical intervertebral discs, in the direction of the adjacent nervous structures (eg: spinal cord of neighboring spinal cord) or in the direction of the nearest vertebral bodies.

    The herniated cervical disc is the cause of spinal stenosis, when the nucleus pulposus invades, following its release, the space reserved for the spinal cord located in the immediate vicinity.

  • Congenital malformations of the cervical spine . Some individuals are born with a spinal canal, along the cervical spine, which is narrower than normal.

    The presence from the outset of a narrowing of the spinal canal (be it along the cervical tract or in another section of the spine) is an example of congenital spinal stenosis.

Did you know that ...

When cervical spinal stenosis is due to cervical spondylosis, doctors also speak of spondylotic cervical myelopathy or spondylogenetic cervical myelopathy .

Cervical myelitis

Myelitis is the medical condition that results from the inflammation of the gray matter or white matter of the spinal cord. When accompanied by the term "cervical", it simply means that the inflammatory process involves the cervical tract of the spinal cord.

Myelitis recognizes numerous causes; in fact, it may depend on viral infections (eg: poliomyelitis, AIDS, varicella virus, herpes zoster and West Nile virus), bacterial infections (eg tuberculosis, syphilis, meningitis and Lyme disease), fungal infections (eg: Cryptococcus neoformans, Coccidioides immitis and Blastomyces dermatitidis ), parasitic infections (eg: Schistosoma, Taenia solium and Trichinella spiralis ), autoimmune diseases (eg: neuromyelitis optica, Sjogren's syndrome, multiple sclerosis and systemic lupus erythematosus) and even some vaccines (eg, hepatitis B, measles, mumps and rubella vaccination, and diphtheria and tetanus vaccine).

The inflammation induced by myelitis affects the functioning of the spinal cord ; this is due to the damage that the aforesaid inflammation brings to the neurons of the gray substance and of the white substance of the spinal cord tract concerned.

Cervical Spinal Injuries of Traumatic Origin

Cervical spinal cord injuries of traumatic origin are the consequence of severe traumas to the cervical tract of the spine, which subject the latter to abnormal movements (eg, hyperflexion, hyperextension, rotation and lateral slippage) or which undermine its integrity ( they cause the fracture of a vertebral body, whose resulting fragments injure the spinal cord).

Among the most frequent causes of such traumas to the vertebral column, there are: motorcycle and car accidents, accidental falls on the back (eg: falls from a horse), acts of physical violence and more (eg: gunshot wounds ) and neck injuries resulting from the practice of contact sports such as, for example, rugby or American football.

Cervical Vascular Myelopathy

With cervical vascular myelopathy, doctors intend a more or less serious suffering of the cervical spinal cord, due to an alteration of the supply of oxygenated blood to the latter (oxygenated blood is essential for the survival of any tissue and organ of the human body, including spinal cord).

Medical conditions that can cause cervical vascular myelopathy include: atherosclerosis (due to its occlusive phenomena), diabetes-induced angiopathy, hematomyelia (is hemorrhage inside the spinal cord), aortic dissection, the polyarteritis nodosa (consists of an inflammation of the arterial vessels with lesion effects), the aforementioned systemic lupus erythematosus, the neurosyphilis and the medullary ischemic phenomena (eg: medullary TIA).

When severe, cervical vascular myelopathy can affect the supply of blood to the cervical spinal cord in such a marked way as to cause the death of the latter due to necrosis (example of spinal cord infarction ).

Risk Factors of Cervical Myelopathies

To promote the development of a cervical myelopathy are factors such as:

  • Infections dangerous for spinal cord health (eg: poliomyelitis);
  • The abnormal blood supply to the spinal cord (for example, due to the presence of atherosclerosis);
  • The presence of an autoimmune disease, such as systemic lupus erythematosus, Sjogren's syndrome, multiple sclerosis and optic neuromyelitis;
  • The presence of a past history of neck injuries (because they are risk factors for cervical spondylosis);
  • The presence of a congenital spinal stenosis with cervical site;
  • The practice of sports or risky jobs for the health of the spine;
  • The appearance of a cervical spinal tumor.

Symptoms and Complications

Possible symptoms of cervical myelopathy include:

  • Neck pain and stiffness in the neck. These two manifestations create difficulty in moving the neck;
  • Pain in the shoulders, upper limbs in the back and lower limbs;
  • Muscular atrophy and weakness in the muscles of the upper and lower limbs;
  • Urinary disorders (eg urinary incontinence and difficulty urinating) and intestinal disorders (eg: fecal incontinence and constipation);
  • Sense of numbness in the face;
  • Loss of the so-called fine motor skills, that is the motor capacity that allows to perform actions like buttoning up a jacket, drawing etc .;
  • Flu symptoms (eg fever, headache, nausea, vomiting, widespread fatigue, loss of appetite, etc.). They characterize the forms of cervical myelopathy sustained by infectious agents, therefore for example viral or bacterial myelitis;
  • Muscle spasms and muscle fasciculations;
  • Posture instability and difficulty walking;
  • Loss of skin sensitivity, soreness, tingling and / or burning sensation in the hands and / or feet (paresthesia);
  • Paralysis of the upper and lower limbs;
  • Loss of reflexes;
  • Cyst formation filled with fluid in the spinal cord (syringomyelia).

Complications

In the absence of adequate therapy or if very severe, cervical myelopathies are diseases that can give rise to complications; specifically, among these complications, the following are worth mentioning: the chronicization of painful sensations, the increasingly frequent recurrence of muscle spasms, total paralysis of the upper and lower limbs, total loss of control of urinary and fecal functions, the onset of sexual dysfunction (erectile dysfunction, for men, and anorgasmia, for women), the depression resulting from having to live with the previous complications and, finally, the onset of serious and potentially deadly cardiovascular problems.

The most serious cervical myelopathies are those in which the spinal cord develops a lesion against its nerve cells. Injuries to nerve cells in the spinal cord (as well as lesions affecting brain nerve cells) are irreversible alterations that cannot be cured in any way.

Diagnosis

For the diagnosis of a cervical myelopathy and the identification of its triggering causes, the information provided by: the patient's symptoms, the medical history, the physical examination, an accurate neurological examination, radiological tests such as myelography, nuclear magnetic resonance in the spine and CT in the spine, blood tests and lumbar puncture .

In addition to providing a wealth of information on the present condition, such a thorough diagnostic procedure allows, in uncertain cases, to exclude pathologies with similar symptoms step by step, but not associated with spinal cord suffering ( differential diagnosis ).

Why is it important to identify the Causes of Cervical Myelopathy?

The knowledge of the causes of a cervical myelopathy is very important, because it is from the causal factors that the most adequate therapy planning depends.

Therapy

The treatment of a cervical myelopathy varies according to the cause and in relation to the severity of the symptoms.

Unfortunately, in situations where a cervical myelopathy is associated with spinal cord injury, even the most scrupulous treatment has limited effects, as, as previously stated, they are injuries with irreversible consequences.

Examples of Therapy

  • If cervical myelopathy is a spinal stenosis due to cervical spondylosis, the treatment will consist, for the less severe cases, in a conservative treatment (anti-inflammatory, physiotherapy, correction of possible postural errors and adoption of a healthy lifestyle) and, for the more severe cases, in a surgical treatment aimed at relieving spinal cord compression (spinal decompressive surgery).
  • If cervical myelopathy is a cervical spinal stenosis resulting from a tumor of the spine (spinal tumor), the therapy will consist in a surgical intervention aimed at removing the tumor mass;
  • If cervical myelopathy is an autoimmune mold myelitis, the treatment will include the administration of corticosteroids and immunosuppressants, in order to alleviate the inflammation present and mitigate the improper response of the immune system (which is the causal factor of the aforementioned inflammation);
  • If cervical myelopathy is a cervical spinal injury of traumatic origin, the therapy will include immobilization, intravenous administration of a corticosteroid with a high anti-inflammatory action, whose name is methylprednisolone, and a surgical operation on the vertebral column aimed at eliminating any abnormalities occurring as a result of the trauma (eg: in the presence of a vertebral fracture, the surgery serves to remove any bone fragments from the fractured vertebra).

Prognosis

The prognosis in the presence of a cervical myelopathy depends on the severity of the triggering cause: if the cause is clinically important (ie severe), the resulting myelopathy leaves little room for recovery; vice versa, if the causal factor is of slight clinical thickness (ie it is not severe), the consequent cervical myelopathy is controllable with good results.