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Treating Myelopathy in Northern New Jersey

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Patients experiencing back pain, numbness down an extremity, difficulty with balance or muscle strength may have myelopathy due to compression of the spinal cord. To secure an accurate diagnosis, patients should visit the team of spine specialists, neurosurgeons, orthopedic spine surgeons, or doctors specialized in treating back pain control at Centers for Neurosurgery, Spine & Orthopedics (CNSO).

CNSO has multiple locations in northern New Jersey, making it easy for those with neck pain or back pain, muscle weakness, or difficulty with coordination, to experience the relief they need at a nearby location.

What Is Myelopathy?

Myelopathy is a constellation of symptoms associated with spinal cord compression. The symptoms of myelopathy appear when there is a compression of the spinal cord at one or more levels of the spine. Some causes of spinal cord compression and the resultant myelopathy are:

Myelopathic symptoms vary depending on the level of the spinal cord being compressed:

Cervical Myelopathy

Cervical myelopathy happens in the neck and is the most common location where myelopathy occurs. Neck pain or paresthesia and bilateral arm radiculopathy are often the symptoms associated with cervical myelopathy. If severe, there will also be bilateral leg radiculopathy and gait disturbances. If cervical compression t becomes too severe, the patient can become a quadriplegic or may even die. Spondylolisthesis can cause cervical myelopathy.

Thoracic Myelopathy

If there is discomfort around the thoracic rib cage, extending down bilateral legs, then thoracic spinal cord compression could be the potential cause. Thoracic myelopathy, which occurs secondary to thoracic spinal cord compression, can be caused by thoracic stenosis, bone spurs, bulging discs, herniated discs, or spinal trauma.

Lumbar Myelopathy

Lumbar myelopathy is a rare condition because the spinal cord typically ends at the top section of the lumbar spine. So, there are only two of the five levels of the lumbar spine in which the spinal cord is present. A patient with a tethered spinal cord could also experience lumbar myelopathy.

Patients who have been diagnosed as either having a compression on their spinal cord, myelopathy, or radiculopathy, should contact Centers for Neurosurgery, Spine & Orthopedics for a second opinion or to discuss treatment options.

What Causes Myelopathy?

Spinal cord compression and the resultant myelopathy could have many causes. Other than a high-impact injury such as a motor vehicle accident or a fall, some of the most common causes are a spinal cord tumor, such as meningioma of the spine or astrocytoma of the spine, or non-tumor related causes such as spondylolisthesis, spinal stenosis, arthritis, and spondylosis. These conditions cause either the spinal cord to malfunction due to compression from either the tumor mass or the reduced space of the spinal canal within which the spinal cord resides.

When the bones in the spine are affected causing growth into the spinal canal, the resulting condition is called spondylotic myelopathy. It can occur at any level of the spinal cord. The compression from the bone damages the nerve fibers of the spinal cord and blocks nerve impulses that normally would be sent to a patient’s arms, legs, and other body parts. The nerve damage leads to weakness, pain, and loss of function.

The symptoms of myelopathy can appear suddenly, secondary to an acute change in the bone structure, which results in an acute onset of myelopathy. Acute myelopathy usually occurs due to a major impact, like a fall, sports injury, motor vehicle accident, or work-related injury. Conversely, arthritic changes slowly progress over time, which is the reason for the slow onset of chronic myelopathy

Symptoms of Myelopathy

When a spinal cord is compressed or injured, a patient with myelopathy is most likely to experience a loss of sensation or function, as well as pain and discomfort. Other symptoms include:

  • Neck, arm, leg, or lower back pain
  • Tingling, numbness, or weakness
  • Difficulty with fine motor skills, such as writing or buttoning a shirt
  • Increased reflexes in extremities or the development of abnormal reflexes
  • Difficulty walking
  • Loss of urinary or bowel control
  • Issues with balance and coordination

Patients will experience different symptoms depending on what level of the spine the cord is compressed. Those who suffer from cervical myelopathy, for instance, usually have symptoms that affect their necks and arms. Thoracic myelopathy or lumbar myelopathy usually involves gait disturbances and leg weakness.

How Is Myelopathy Diagnosed?

To start, a doctor will conduct a physical examination of the patient and go over their medical history to rule out other medical or painful conditions. If the neurosurgeon, orthopedic surgeon, or pain management doctor at CNSO becomes concerned there may be a spine, brain, or musculoskeletal-related cause, they will order one of these other tests, depending on what tests have already been ordered and the patient’s other medical conditions:

  • X-rays: An X-ray can rule out any other spinal conditions that could lead to myelopathy.
  • Magnetic Resonance Imaging (MRI): An MRI is the best way to get a clear image of the spinal cord, spinal canal nerve roots, intervertebral discs, and ligaments to identify signs of compression in the spine.
  • CAT scan: Like an MRI, a CAT scan can be used when an MRI is contraindicated due to pre-existing metal in the patient.
  • Myelography: Using a real-time X-ray called fluoroscopy, along with a contrasting dye, myelography can find irregularities in the spine. This test is used if a patient cannot use an MRI machine.
  • Torg Ratio: Using the above imaging, the doctor can measure the diameter of the spinal canal and detect spinal cord compression.

If symptoms similar to myelopathy are a complication of another disease, unrelated to a structural impediment of the spinal cord, the medical professional may refer to it in terms of the disease. For example, diabetic myelopathy means that the patient with diabetes has symptoms that mimic spinal cord damage secondary to diabetes. This condition seldom occurs but is common enough to mention.

Can Myelopathy Be Treated Without Surgery?

Assuming the cause of myelopathy is not a spinal cord tumor, and the symptoms and the results of the imaging show the spinal cord compression to be mild, CNSO spine experts will try to resolve the symptoms through conservative management. Pain management can include using over-the-counter anti-inflammatory drugs. Another non-surgical treatment for myelopathy can be bracing and physical therapy. The doctors may recommend a pain management specialist inject steroids near the compressed spine area to reduce swelling.

Other non-surgical treatments for myelopathy patients that may be recommended by a doctor at CNSO are:

  • Epidural steroid injections
  • Transforaminal injections
  • Caudal injections
  • Home exercise program and lifestyle changes

Treating Myelopathy with Surgery

If myelopathy pain cannot be managed with the non-surgical treatments listed above, the medical and surgical team at Centers for Neurosurgery, Spine & Orthopedics may determine a surgical solution is necessary.

The type of surgery recommended by a neurosurgeon will depend on the type of myelopathy a patient has. Some of the factors a neurosurgeon or orthopedic fellowship-trained spine surgeon will use to determine which surgical method to recommend include:

  • Location of myelopathy pain
  • Type of spinal cord tumor
  • History of previous spinal treatments
  • Level of activity
  • Anatomy of the spine
  • History of back trauma
  • Other medical problems

Only a neurosurgeon is trained to remove a tumor from the spine.

Surgical options for patients with myelopathy include:

Spine Decompression Surgery

Spinal decompression surgery is a common surgical option intrinsically meant to relieve pressure on the spinal cord. This type of operation is often used to treat herniated discs or to remove bone spurs. During the procedure, bone or tissue are modified or removed to relieve pressure causing compression on the spine.

Laminectomy

A laminectomy is a surgical procedure in which a portion of the lamina, bony arches that protect the back of the spinal cord, are removed. The procedure is often done to relieve pressure off the spinal cord or adjacent nerves.

Minimally Invasive Spine Surgery

The neurosurgeons and orthopedic spine surgeons at CNSO use the latest technology to treat spine issues, including minimally invasive spine surgery to treat myelopathy. Minimally invasive spine surgery uses a small incision where a microscopic camera and surgical tools are inserted into the area where surgery occurs. Many times, a minimally invasive procedure allows a patient to go home on the same day as surgery. Other benefits of minimally invasive spine surgery include:

  • Less scarring of skin and muscle due to the small incision
  • Less bleeding during surgery
  • Less exposure to imaging radiation
  • Lowered risk of infection
  • Lower pain medication requirements during recovery
  • Shorter recovery time

Because spinal cord compression can cause permanent damage, including loss of function of the extremities and incontinence, doctors want to identify myelopathy in its early stages to increase the chances of a full recovery.

The medical team at CNSO works with each patient to customize a treatment plan and determine the best course of action to allow each patient to live their best life — pain-free.

Let CNSO Help With Myelopathy, the Associated Pain, and the Potential for Disability

At Centers for Neurosurgery, Spine & Orthopedics, the dedicated surgical and non-surgical team understands how myelopathy can impact daily life. Patients receive comprehensive and coordinated care so they can resume a healthy lifestyle, free from disability, from CNSO’s leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists.

CNSO offers multiple convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about effectively treating myelopathy, northern New Jersey patients can contact the medical team at CNSO today.

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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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