Thoracic Spine Myelopathy
What is myelopathy?
Myelopathy is the term used to describe compression of the spinal cord that causes nerve dysfunction. When it affects people 50 and older it typically develops gradually and slowly progresses over months or years with a steady decline in function due to degenerative changes caused by osteoarthritis. However, it can also develop quickly once an underlying condition progresses to compression and produces symptoms. Acute myelopathy can result from an injury or infection.
The most common sites for myelopathy are the cervical spine (neck) and lumbar spine (low back). Thoracic spine myelopathy affects the spine in the middle of the back. The causes of thoracic spine myelopathy are fractures, herniated discs, bone spurs (osteoarthritis), cancer metastases, and trauma.
A herniated disc is where the intervertebral disc is compressed, and the jelly-like center pushes against the edge of the disc or bulges into the spinal canal and puts pressure on the spinal canal or nerve roots. Bone spurs develop from a disc that dries out and flattens causing the vertebrae to rub together which causes the body to create bone spurs around the disc and stiffen the spine or narrow the spinal canal (spinal stenosis).
Some people have no pain. Symptomatic myelopathy symptoms include:
- loss of function or sensation
- back pain
- pain when walking
- loss of coordination and balance
- tingling, numbness and pain around the area of compression, and
- radiating pain.
In the more severe cases symptoms also include:
- difficulty walking
- muscle weakness and muscle wasting
- loss of reflexes
- loss of urinary and bowel control and sexual function
The range of symptoms or the lack thereof make it difficult to distinguish myelopathy from other disorders. During your diagnosis your Ortho Illinois specialist will take a thorough history and conduct a complete physical exam to evaluate the stability of the spine, and other conditions that may be involved, such as spinal stenosis. Imaging studies are vital to an accurate diagnosis and include an MRI, CT scan and X-rays. Additional testing to examine nerve function may be recommended.
Treatment depends on the cause. When the cause is irreversible treatment will be designed to relieve symptoms and slow progression.
Nonsurgical management is intended to treat the discomfort and may include physical therapy, bracing, muscle relaxants, traction, and anti-inflammatory medications. For additional pain relief, epidural steroid injections are available. Many patients achieve symptom relief with nonsurgical management and will be followed for long periods.
Surgery may be the only option for patients with intractable pan and significant motor and sensory dysfunction. Decompression surgery can reverse the condition by treating the cause. However, when the spinal cord is damaged, complete reversal may not be possible.
Decompression surgery is called a laminectomy which may be performed minimally invasively or with open surgery. Laminectomy has been proven to be safe and effective and provides improvement in function and quality of life.
At Ortho Illinois Spine Care our board-certified, fellowship trained orthopedic and neurosurgeons are experts in the diagnosis and treatment of spine disorders. Ortho Illinois Spine Care is a regional spine center for people in northern Illinois and the Chicago region who are suffering with neck and back pain. Our goal is to help relieve our patients’ pain and restore their function so you can get back to the life they love. When you suffer with mid back pain and function problems that last more than several weeks, contact Ortho Illinois for a consultation.