Why does the spinal cord suffer?
With age, intervertebral discs lose height, bone growths form along the edges of the vertebrae, ligaments thicken, and the lumen of the spinal canal narrows. If the canal is initially narrow, even moderate changes lead to compression of the spinal cord. Constant pressure impairs blood supply to tissue and damages pathways. In addition to spondylogenic, there are vascular myelopathy due to impaired blood flow, inflammatory due to autoimmune and infectious processes, dysmetabolic due to vitamin B12 deficiency, as well as tumor and post-traumatic forms.
- Spondylogenic - most common in adults
- Disc herniation and ligament thickening
- Tumors of the spine and spinal cord
- Vascular disorders
- Vitamin B12 and copper deficiency
- Inflammatory and infectious causes
- Consequences of injury
Symptoms
The disease often develops gradually. One of the early signs is a deterioration in fine motor skills: it becomes difficult to fasten buttons, write, grasp small objects, hands feel like someone else’s. Then there is a feeling of instability, an unsteady gait, a feeling of weak legs, and the need to hold on to the walls. Numbness and tingling may occur in the arms, legs, or torso. Characterized by an increase in muscle tone and revitalization of reflexes below the level of the lesion. Urinary problems usually appear later and indicate significant damage.
- Clumsiness and weakness in the hands
- Unsteadiness of gait and imbalance
- Numbness in the arms, legs, or torso
- Increased muscle tone and spasticity
- Sensation of current passing through the back when tilting the head
- Urinary disorders in later stages
Diagnostics
A neurological examination allows one to suspect the level of damage by the distribution of weakness, changes in reflexes and sensitivity. The main method of confirmation is magnetic resonance imaging of the corresponding part of the spine: it shows the degree of narrowing of the canal, compression of the spinal cord and changes in its tissue. X-ray with functional tests evaluates instability, CT scan clarifies the condition of bone structures. Electroneuromyography helps distinguish myelopathy from polyneuropathy and amyotrophic lateral sclerosis. Tests are required to rule out vitamin B12 deficiency and inflammatory causes.
- Neurological examination with assessment of reflexes
- MRI of the cervical and thoracic spine
- X-ray with functional tests
- CT scan for bone changes
- ENMG
- Vitamin B12 and inflammatory markers
- Consultation with a neurosurgeon for compression
Treatment
Tactics depend on the cause and the rate of increase in symptoms. With mild manifestations and slight compression, observation with rehabilitation, physical therapy and limitation of traumatic loads is possible. If the spinal cord is clearly compressed and the symptoms increase, surgery becomes the main method: widening the spinal canal and eliminating the compressing structures. The point of intervention is primarily to stop the deterioration, and the degree of recovery depends on how long the pressure has been present. In metabolic and inflammatory forms, the underlying cause is treated.
- Observation and rehabilitation for mild forms
- Surgical decompression as symptoms worsen
- Replenishment of vitamin B12 deficiency
- Treatment of inflammatory and vascular causes
- Therapeutic exercise and fall prevention
- Avoiding sudden movements and neck injuries
- Observation by a neurologist over time
What not to do
If compression of the spinal cord is suspected, rough manual manipulation of the neck, sharp traction, and independent exercises with strong bending and rotation of the head are dangerous. Such effects can dramatically worsen the condition. Warming up, massage and physiotherapy without an established diagnosis delay the examination and waste time. Also, clumsiness and unsteadiness should not be explained only by age: these symptoms require an objective assessment, because with timely intervention the prognosis is much better.
- Do not perform manual therapy on the neck without a diagnosis
- Do not perform sudden stretches or head rotations
- Do not delay MRI if symptoms worsen
- Do not take painkillers instead of examination
- Don't ignore urinary problems