Spinal Cord Compression

Causes of spinal cord compression

Spinal cord compression can occur when the cervical vertebrae start to deteriorate with age. The degenerative changes that can be a natural part of aging can affect the cervical vertebrae, discs and joints, which can tighten the area around the spinal cord. Herniated discs and bone spurs are two types of conditions that can lead to spinal compression.

Other causes of spinal cord compression include:

• Rheumatoid arthritis— rheumatoid arthritis, an autoimmune disease that attacks a person’s own tissues, can cause swelling, which leads to pressure on the joints in the cervical spine. When this occurs, the amount of space available for the spinal cord may be reduced.
• Injury — an injury to the neck from a car accident, sporting event or other traumatic injury may cause the spinal cord to be pushed out of normal position, which can lead to cervical spondylotic myelopathy

Risk factors for spinal cord compression

There are several factors that increase your likelihood of developing spinal cord compression including:

• Age — cervical spondylotic myelopathy is more common as people age. Most cases occur in patients over 50 years old.
• Small spinal canal — if you were born with a smaller spinal canal, you are at greater risk of developing cervical cord compression.

Symptoms of spinal cord compression

The primary symptoms of spinal cord compression are:

• Neck pain
• Pain or heavy feeling in legs and arms
• Shooting pains down the arms or legs
• Trouble walking or balancing
• Difficulty performing activities such as typing, threading a needle, picking up a marble
• Limited range of motion
• Loss of bladder or bowel control (serious cases)
• Paralysis 

Diagnosis for spinal cord compression

Cervical spondylotic myelopathy can be diagnosed in a thorough physical and neurological examination with an experienced spine doctor. During a physical exam, your doctor will evaluate your symptoms and look for signs of spinal cord compression such as loss of sensation, abnormal reflexes or neck pain.

To determine the underlying cause, your doctor may order imaging studies such as:

• X-ray — a spinal x-ray may identify bone growths that are compressing the spinal nerves.
• Magnetic resonance imaging (MRI) — a powerful magnetic field and radio frequency signals provide a detailed image of the spinal cord and surrounding structures.
• Computed tomography (CT scan) — the scan will take a series of detailed pictures at different angles of the spinal cord and surrounding structures to determine if the spinal canal is narrowed.
• Myelogram — a myelogram is a type of CT scan where contrast dye is injected into the spinal canal. The dye helps amplifies the spinal cord and nerve roots in the x-ray images.

Treatment for spinal cord compression

The goal of treatment for cervical cord compression is to relieve the pressure on the spinal column and reduce the severity of symptoms. Your spine doctor will discuss a variety of treatment options with you to determine the best treatment for your case.

Your physician will most likely start your treatment plan with nonsurgical treatment options including:

• Medication — over-the-counter and prescription medications like non-steroidal anti-inflammatory drugs (NSAIDS) may be effective in treating mild to moderate pain and inflammation.
• Steroid injections — your doctor may inject cortisone or other steroids into the epidural space in the spine to temporarily relieve pain associated with cervical spondylotic myelopathy.
• Physical therapy — physical therapy can help strengthen muscles around the spine
• Massage — therapeutic massage can relieve pressure in the muscles around the spine and in the connective tissue.
• Lifestyle modifications — adjusting physical activity or eliminating positions or movements that cause pain will help relieve symptoms associated with spinal cord compression.

Nonsurgical treatments typically don’t address the underlying problem, so if your case of spinal cord compression is becoming more severe, you may need cervical spine surgery. The goal of a cervical spondylotic myelopathy surgery is to reduce the pressure on the spinal cord. 

Procedures used to treat cervical cord compression include:

Anterior Cervical Discectomy and Fusion
During an anterior cervical discectomy and fusion, your doctor can remove herniated discs or disc material and then stabilize the spine through spinal fusion. The goal of spinal fusion is to stabilize the spine by fusing the vertebrae, so they heal into a single bone. 

Anterior Cervical Corpectomy and Fusion
An anterior cervical corpectomy and fusion is an anterior spinal decompression approach (approaching the neck from the front) that is similar to the anterior cervical discectomy. During this procedure, a bone is removed to relieve the pressure on the spinal cord. The surgeon will then perform a spinal fusion to stabilize the spine.

Laminectomy
A laminectomy procedure is a posterior spinal decompression approach (approaching the neck from the back) that relieves pressure on the spinal cord and/nerves by enlarging the spinal canal. During the procedure, your surgeon will remove the lamina. The lamina is the part of the vertebra that covers the spinal canal. Laminectomy can be performed without fusion or with fusion. Typically, results are better with fusion.

Laminoplasty
Laminoplasty is an alternative posterior spinal decompression approach that relieves pressure on the spinal cord by creating more space for the spinal cord and nerve roots.  Spinal fusion is not performed in this procedure.