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Home › Conditions › Cervical Myelopathy

Spinal Cord Compression

Cervical Myelopathy

Cervical myelopathy is compression of the spinal cord in the neck — the most common cause of spinal cord dysfunction in adults. It is progressive and often underdiagnosed. Early surgical decompression is the most reliable way to halt progression and preserve function.

Overview

Understanding Cervical Myelopathy

Cervical myelopathy occurs when degenerative changes in the cervical spine — including bone spurs, disc herniations, and thickening of the posterior longitudinal ligament or ligamentum flavum — compress the spinal cord itself. Unlike a pinched nerve root (radiculopathy), which causes symptoms in one arm, myelopathy involves the cord and can produce dysfunction throughout the body below the level of compression.

It is the most common cause of spinal cord impairment in adults over 50 and is frequently misattributed to normal aging, peripheral neuropathy, or balance disorders. Early recognition is critical because the cord does not predictably recover from prolonged compression, and outcomes are substantially better when surgery is performed before severe deficits develop.

Common Symptoms
  • Hand clumsiness — difficulty with buttons, writing, utensils
  • Unsteady or wide-based gait
  • Weakness in the arms or legs
  • Numbness or tingling in the hands
  • Electric shock sensation down the spine with neck flexion (Lhermitte's sign)
  • Heaviness or stiffness in the limbs
  • Bowel or bladder changes (advanced cases)
Common Causes
  • Degenerative disc disease and bone spur formation
  • Cervical disc herniation
  • Thickening of the posterior longitudinal ligament (OPLL)
  • Ligamentum flavum hypertrophy
  • Congenitally narrow spinal canal
  • Cervical instability or spondylolisthesis
  • Prior cervical surgery with adjacent segment degeneration
Why Early Evaluation Matters

A Progressive Condition

Myelopathy does not reliably stabilize or improve on its own. The natural history includes slow, stepwise deterioration — with the risk of sudden worsening after even minor trauma such as a fall or fender-bender. The spinal cord has limited capacity for recovery once significant compression has been sustained for an extended period.

⚠ Seek prompt evaluation if you experience:
Sudden worsening of hand function or gait, new bowel or bladder changes, or significant weakness in the arms or legs. These may indicate rapid cord deterioration requiring urgent assessment.

Myelopathy severity is commonly graded using validated scales such as the modified Japanese Orthopedic Association (mJOA) score, which assesses hand function, arm and leg motor ability, and bowel/bladder control. This grading helps guide surgical decision-making and track outcomes over time.

Mild
Minor hand clumsiness or gait changes; function largely preserved. May be observed with close monitoring in select patients.
Moderate
Noticeable functional impairment in daily activities; difficulty walking or using hands. Surgery is typically recommended.
Severe
Significant disability; possible bowel/bladder involvement. Surgery is urgent — outcomes are less predictable after prolonged severe compression.
Treatment

Surgical Decompression Options

Surgery is the primary treatment for cervical myelopathy of moderate or greater severity. The goal is to relieve pressure on the spinal cord, stabilize the spine where needed, and create conditions for neurological recovery. Our neurosurgeons tailor the surgical approach to the individual patient's anatomy, the pattern and extent of compression, and overall health.

1
Anterior Cervical Discectomy and Fusion (ACDF)
The most common approach for 1–3 level disease. The disc and compressive material are removed from the front of the neck, and the space is stabilized with a cage and plate. Provides direct access to the most common sources of cord compression.
→ Learn about ACDF
2
Posterior Cervical Laminectomy and Fusion
Preferred for multilevel compression or when the anatomy favors a posterior approach. The lamina is removed to widen the spinal canal from behind, and the spine is stabilized with rods and screws to prevent instability.
→ Learn about Posterior Cervical Fusion
3
Cervical Disc Replacement (Arthroplasty)
In carefully selected patients with single or two-level disease, an artificial disc can replace the damaged disc while preserving motion at that segment — potentially reducing stress on adjacent levels over time.
→ Learn about Cervical Disc Replacement
The information on this page is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified physician regarding your specific condition. Surgery is not appropriate for every patient, and our physicians evaluate each case individually.
Related Conditions

Other Conditions We Treat

Disc Herniation
Cervical and lumbar
Neck Pain
Cervical degenerative disease
Adjacent Segment Disease
Degeneration after spinal fusion
Sciatica
Radiating leg pain
Back Pain
Lumbar and thoracic
Spinal Stenosis
Canal narrowing
Patient Questions

Frequently Asked Questions

Cervical myelopathy is compression of the spinal cord in the neck, most commonly caused by degenerative changes such as bone spurs, thickened ligaments, and disc herniations that narrow the spinal canal. Unlike radiculopathy (pinched nerve root), myelopathy involves the cord itself and can affect function in the hands, arms, legs, and bladder. It is the most common cause of spinal cord dysfunction in adults over 50.
The hallmark symptoms of cervical myelopathy include hand clumsiness (difficulty buttoning shirts, writing, or using utensils), unsteady gait, and weakness in the arms or legs. Patients often describe a feeling of heaviness or stiffness in the limbs. Neck pain may or may not be prominent. In advanced cases, bowel or bladder dysfunction can occur. Symptoms often develop slowly and may be mistaken for normal aging.
Yes. Cervical myelopathy is a progressive condition — the spinal cord does not reliably recover on its own, and most patients experience gradual worsening without treatment. Episodes of sudden deterioration can also occur, particularly after minor trauma. Early evaluation and treatment are important because outcomes are significantly better when surgery is performed before severe or prolonged spinal cord compression occurs.
Surgery is the primary treatment for cervical myelopathy of moderate or greater severity. The goal is to decompress the spinal cord and, when necessary, stabilize the spine. Surgical options include ACDF (anterior cervical discectomy and fusion), posterior cervical laminectomy with or without fusion, and in select patients, cervical disc replacement. The approach depends on the number of levels involved, the direction of compression, and the patient's overall anatomy and health.
Surgery for cervical myelopathy aims to halt progression and, in many patients, achieve partial or meaningful recovery of function. Outcomes are best when surgery is performed before severe neurological deficits develop. Hand function and gait often improve significantly. Complete recovery of pre-existing deficits is less predictable and depends on the duration and degree of cord compression. Our surgeons will provide a realistic assessment based on your imaging and clinical examination.
Diagnosis is based on a combination of clinical history, neurological examination, and MRI of the cervical spine. MRI is the most important imaging study and can reveal the degree of spinal cord compression as well as any changes within the cord itself (called myelomalacia or T2 signal change). CT myelography may be used in patients who cannot undergo MRI. Nerve conduction studies and EMG help distinguish myelopathy from other neurological conditions.
→ Spine Surgery Services at Neuroscience Specialists
(405) 748-3300  ·   Fax: (405) 749-1671  ·  Monday – Friday 8:00 AM – 5:00 PM
Clinical References
↗AANS — Cervical Myelopathy ↗Nouri et al. — CSM Natural History (2015) ↗North American Spine Society

Concerned About Myelopathy?

A neurological examination and MRI review with one of our fellowship-trained neurosurgeons will clarify your diagnosis and options — surgical and non-surgical.

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