Cervical myelopathy means the spinal cord itself is being squeezed and strangled in your neck.
The early signs are SUBTLE:
- feeling unsteady on your feet,
- arms that feel clumsy or numb, and
- legs that feel stiff or heavy.
- NOTE: Neck pain may be mild or missing.
It’s different from a pinched nerve.
A pinched nerve irritates one nerve root and usually settles on its own. Myelopathy presses on the cord, tends to get WORSE slowly over years, and damage to the cord may not fully recover.
That’s why surgery is often recommended once it’s moderate or getting worse. Without surgery, somewhere between 1 in 5 and more than half of people with symptoms get worse over the following few years.
What causes it
- Wear and tear in the neck. Discs bulge, bone spurs grow and ligaments thicken, and together they narrow the canal the cord runs through
- Age: it usually starts after 40 and is most often found in people in their 50s and 60s
- A naturally narrow canal makes it more likely, and can bring it on younger
- It’s more common in men
The subtle signs
- Balance changes: feeling unsteady, walking with your feet wider apart, reaching for rails, or bumping into doorframes. It’s often worse in the dark
- Clumsy arms: arms that feel awkward, heavy or not quite under your control
- Arm numbness or tingling, often in both arms and in patchy areas
- Stiff, heavy legs: a stiff or jerky walk, tripping more, or legs that tire quickly
- Electric shocks down your spine or into your arms and legs when you bend your neck forward
- Bladder changes: needing to pee urgently or more often. This tends to come later
These signs creep up, so people often put them down to age. It’s commonly missed for a long time, and a late diagnosis can mean a poorer result.
Pinched nerve or myelopathy?
- Pinched nerve: usually one arm, with sharp or burning pain following one path. It usually improves over weeks to months. See pinched nerve in the neck
- Myelopathy: often both sides, with balance and the legs involved. Pain may be mild. It usually changes slowly and tends to get worse
- They can happen together. The same disc or bone spur can press on a nerve root and on the cord
A pinched nerve hurts. A squeezed spinal cord often just feels wrong.
How it’s diagnosed
- Examination: reflexes that are brisker than normal, and tests of walking and balance
- MRI: shows where the cord is squeezed, and sometimes a change inside the cord itself
- Compression without symptoms is common. Many older adults have some narrowing on MRI and no signs of myelopathy. That doesn’t automatically mean surgery, but you should be watched and know the warning signs
- Lower back narrowing is a different problem. See spinal stenosis
Why surgery is often recommended
- Exercise can’t make space. Physio, collars and medicines can ease symptoms, but they don’t widen the canal around the cord
- The main aim is to stop it getting worse. Many people improve after surgery, but some of what’s been lost may not come back, especially if it’s been there a long time
- Mild and stable: some people are watched closely with physio and regular checks, with surgery if things change
- Moderate, severe or worsening: surgery is usually advised
- The operation: from the front, removing the disc or bone pressing on the cord, as in ACDF. Or from the back, removing or hinging open bone to give the cord room. Your surgeon chooses based on where and how many levels are squeezed
The American Academy of Orthopaedic Surgeons has a patient guide to cervical spinal cord compression that explains the surgical options in more detail.
Living with it while you decide
- No neck manipulation. Quick, forceful twisting of the neck by anyone is not safe with a squeezed cord
- Protect yourself from falls. A fall or whiplash can injure an already narrowed cord more easily. Good lighting, rails on stairs and sensible footwear matter
- Keep moving. Walking, balance work and general strength help you stay steady and fit for surgery if you need it
- Keep a simple record. Note changes in walking, balance and arm feeling so you can report them accurately
Go to the emergency department now if
- Your balance gets suddenly worse, or you start falling
- You have new weakness in both arms or both legs
- You have new trouble controlling your bladder or bowels, or can’t pee
- Numbness spreads through both legs or up your body
- You injure your neck in a fall or accident and have any new numbness or weakness
See your doctor or spine surgeon soon if
- Balance, walking or clumsy arms are slowly getting worse over weeks
- You get electric shocks when you bend your neck
- You’re tripping more than you used to
Mention it at your next review if
- You’ve noticed any new arm numbness or leg stiffness, even if it’s mild
- You’re unsure whether your symptoms have changed since your last scan
Neck pain can wait. Wobbly legs and clumsy arms can’t.