Cervical Myelopathy Treatment Options

• Non-surgical treatment is often considered for mild symptoms or in patients with contraindications to surgery.
• Anti-inflammatory drugs (NSAIDs) or acetaminophen can be used to alleviate mild pain and inflammation.
• Muscle relaxants may help reduce muscle spasms.
• Corticosteroid injections can be used to reduce inflammation around the spinal cord and nerves.
• Physical therapy focuses on improving neck strength, flexibility, and overall posture. Specific exercises can be designed to avoid further spinal cord compression while strengthening supporting muscles.
• A cervical collar or brace may be used temporarily to immobilize the neck, reducing movement and allowing the affected area to rest and heal.

Non-surgical treatments are typically indicated for mild symptoms without significant neurological impairment, for patients who cannot undergo surgery due to poor overall health, or when the condition is stable and not progressing rapidly. When symptoms persist or worsen despite nonsurgical treatments, surgery may be necessary.

Surgery is considered when there is moderate to severe myelopathy with neurological deficits such as weakness, numbness, or coordination problems, or when symptoms are progressive and do not respond to conservative treatment. The goal is to increase the canal space to reduce or eliminate cord compression.

Minimally Invasive Spine Surgeon Dr. Mathew Cyriac will consider surgery if symptoms persist for more than six months and are progressing. The timeliness of intervention is critical. Patients with mild myelopathy and less than six months of symptoms have improved surgical outcomes. Surgery may be performed from the front of the neck (anterior) or the back of the neck (posterior). The optimal surgical approach depends on the patient’s specific factors. Dr. Cyriac will make recommendations based on your specific needs.

Anterior Cervical Discectomy and Fusion (ACDF)

This is the most common operation for cervical myelopathy. The damaged, herniated, or degenerated disc causing the compression is removed through an incision in the front of the neck, and the affected vertebrae are fused together to stabilize the spine. Fusion is typically accomplished with a bone graft from the patient or a donor. After surgery, the patient may need to wear a neck brace for several weeks and participate in physical therapy to regain strength and mobility. This minimally – invasive option is used when disc herniation is the primary cause of myelopathy.

Cervical Laminoplasty

This is a motion-sparing option to widen the spinal canal. It is a non-fusion decompression procedure indicated for patients with multilevel stenosis under certain circumstances. The lamina acts as a protective layer over the spinal cord and nerves. This procedure is designed to decompress the spinal cord in the cervical (neck) region without removing the lamina completely.

The goal is to relieve pressure on the spinal cord while maintaining the stability of the cervical spine. This is achieved by creating a hinge on one side of the lamina and then elevating and securing the other side to widen the spinal canal. It is generally chosen over other procedures when preserving spinal motion is important or when there is a need to decompress multiple levels of the spine without causing significant instability.

Posterior Cervical Decompression with Fusion

This is a surgical procedure to relieve pressure on the spinal cord and nerves in the cervical spine (neck region) while stabilizing the spine. Decompression is done by removing or trimming the structures causing the compression. This can include bone spurs, herniated discs, or thickened ligaments. The decompression is performed from the back (posterior) of the neck, allowing direct access to the affected areas. After decompression, spinal fusion is performed to stabilize the spine.

Fusion involves placing bone grafts or implants between the affected vertebrae. The grafts can be harvested from the patient (autograft) or a donor (allograft), or they may be synthetic materials. Metal hardware is often used to secure the vertebrae and promote the fusion process. Over time, the bone grafts encourage the vertebrae to grow together into a single, solid piece of bone, thereby stabilizing the spine and preventing further movement that could cause pain or neurological symptoms. Benefits include stabilization, symptom relief, and prevention of future damage.