What is Cervical Myelopathy?
70% of people over the age of 70 have degeneration in their cervical spine. These people, in many cases, do not have any symptoms of spinal cord degeneration despite the degeneration showing up on imaging. These changes that happen in the spine are classified as arthritic changes and can result in stenosis of the spinal canal (narrowing of the spinal canal), or a lateral recess that may or may not include the foramen. Spinal stenosis can occur centrally which means it is compressing the spinal cord. Stenosis may also occur laterally which compresses a specific nerve root that may result in symptoms in various locations in the affected upper extremity. Learn what you can do to help with neck pain associated with cervical myelopathy.
What are the symptoms?
Cervical myelopathy is another name for central spinal stenosis. Patients with cervical myelopathy will present with upper motor neuron signs and symptoms. These may be symptoms such as a positive Babinski test (The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot), a positive Inverted Supinator sign (tapping on the brachioradialis muscle fails to flex the elbow but instead flexes the fingers), a positive Hoffman’s test (tapping on the brachioradialis muscle fails to flex the elbow but instead flexes the fingers.), hyperactive reflexes, as well as, patients may experience potential sudden bowel and bladder changes. Additionally, there may be some form of walking difficulties or changes that occur in individuals which can look like unsteady, staggering gait.
What Can Be Done to Help?
Patients may be referred to an additional neurologic provider should they present these types of symptoms to perform additional imaging on the cervical spine to assess the amount of spinal cord compression. Many patients who have cervical spine degeneration do not have severe compression which allows for them to continue their physical therapy plan of care. Physical therapists may utilize various forms of interventions to assist patients in their rehabilitation should they present with cervical myelopathy. Manual interventions may be used to restore range of motion and decrease pain. Active exercise may be used to establish endurance and baseline strength to allow for the body to be in more optimal positions to be able to perform ADLs with minimal pain. Patients may also simulate daily tasks such as dressing or brushing their teeth to re-establish their capabilities of performing these tasks without compensations occurring.
Physical therapy can be a very effective conservative treatment option method utilized to assist patients in their return to having pain-free living. The main goals of physical therapy should be to manage symptoms to the best of our abilities, provide pain relief, prevent further neurological decline as well as maximize function. It has been shown through research as well that surgical management has not shown superior outcomes when compared to conservative management after a two-year follow-up appointment with a surgeon. This can allow for patients to feel more comfortable with allowing for conservative treatment methods to be utilized to assist their return to minimal pain living and restoring their quality of life.
Patients who experience any symptoms like this should reach out to their physician. The Physical Therapists at Freedom Physical Therapy Services are trained to help you navigate the management process of cervical myelopathy.