Myelopathy

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Original Editors - Bram Van Laer

Top Contributors - Lena Vanderaa, Simisola Ajeyalemi, Vidya Acharya, Admin, Manisha Shrestha, Rachael Lowe, Kim Jackson, Tony Lowe, Kai A. Sigel, Karen Wilson and Khloud Shreif  

Search Strategy

Databases
• Pubmed
• Web of Knowledge
• Google Scholar
• Medscape
Search Words
• Myelopathy
• Lumbale myelopathy
• Thoracic myelopathy
• Compressive myelopathy

Definition/Description

Myelopathy is a term used to describe any neurologic deficit related to the spinal cord. It’s usually due to compression of the spinal cord by osteophyte or extruded disc material. It is most commonly localized in the cervical spine but it can also occur in the thoracic and lumbar spine.⁵
There are many primary infectious, inflammatory, neurodegenerative, neoplastic vascular, idiopathic and nutritional disorders that results in myelopathy. These causes are much less common than disco genic diseases, metastases or trauma. Further explanations will be given in the following paragraphs.⁵
To determine the grade of severity of the myelopathy you can use the Nurick classification. The classification is based on abnormalities in the patient’s gait.⁷ This evaluation has demonstrated its sensitivity and validity. ⁸

The diagnosis of myelopathy depends on the neurological localization in the spinal cord, rather than the brain or peripheral nervous system. Also, the presence or absence of significant pain or trauma and the mode of onset is primordial to assess the myelopathy into clinical categories.⁵

Clinically Relevant Anatomy

The spinal column begins in the cervical region under the skull. It continues into the thoracic region and finally into the lower back where it connects to the sacrum and pelvis. The cervical region consists of 7 vertebrae, the thoracic region of 12 vertebrae and the lumbar region of 5 vertebrae.
Between the corpus and the proccesus of the vertebrae is the spinal canal. It’s a region in the middle of the spine where the spinal cord goes down and nerves travel toward the extremities. The brain and the spinal cord are packed in 3 membranes: dura mater, arachnoid mater and pia mater. Each one has their own structure and function.
Even though the spinal cord is well protected, it can be damaged by epidural or intradural causes. This is what’s happens when we’re talking about myelopathy.¹¹

Epidemiology /Etiology

Myelopathy can sometimes be a slow process. The symptoms can develop slowly over a period of months or it can go very fast.
It’s difficult to clinically distinguish myelopathy from other non-traumatic causes of myelopathy because the classic history is frequently absent or difficult to elicit from a seriously ill patient.

There are many risk factors that may cause or occur thoracic myelopathy.

Thoracic myelopathy occurs because of:
• Discus hernia⁵
• Spinal degeneration
• Facet degeneration
• Ligamentum flavum hypertrophy^2,4
• Calcification of ligamentum flavum^2,4
• Compression due to extradural mass (Spinal tumors)⁵
• Posttraumatic deformities⁵
• Infections⁵
• Angular kyfose (congenital, tuberculous, neurofibromatosis and posttraumatic kyphosis)³
• Vascular disorders (vascular malformations, spinal cord infarct and epidural hematoma)⁵
• Nutritional disorders⁵

Risk factors¹:

1. Age
2. Degrees of motor and sensory deficits

Degrees of spinal cord compression, absence of proximal stenosis and intramedullary hypertension this factors predicted the surgical outcome.

Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

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Examination

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Key Research

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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