Cervical Myelopathy

Myelopathy describes any neurologic deficit related to the spinal cord. Myelopathy is usually due to compression of the spinal cord by osteophyte or extruded disk material in the cervical spine. Any space occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy. According to Nuti, Vassal and Brunon (2013) conditions such as vascular, inflammatory, nutritional deficiency and post-radiation are commonly lead to myelopathy. Other common sources of myelopathy are cord compression due to extradural mass caused by carcinoma metastatic to bone, and blunt or penetrating trauma. Many primary neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic disorders can also result in myelopathy, though these are much less common than a discogenic disease, metastases, and trauma. A variety of cysts and benign neoplasms can also compress the cord; they tend to arise intradurally. The most common of these are meningiomas, nerve sheath tumors, epidermoid cysts, and arachnoid cysts. (Seidenwurm, 2008)

Cervical myelopathy is predominantly due to pressure on the anterior spinal cord with ischaemia as a result of deformation of the cord by anterior herniated discs, spondylitic spurs, an ossified posterior longitudinal ligament or spinal stenosis. Trauma involving the spine is a common cause of disability. There are approximately 12,000 new quadriplegics or paraplegics each year and 250,000 existing victims in the United States alone. Approximately 60% of spinal cord injuries involve the cervical region. The goals of imaging the patient with cervical spine trauma include detection of fractures, cord injury, or compression and determining the potential for instability. Clinical instability is defined as the inability to maintain normal associations between vertebral segments while under physiologic load (Feller, 2002). In general, disorders of the spinal cord itself are uncommon and difficult to treat effectively. Therefore, most attention in the radiological evaluation of myelopathy is focused on extrinsic compression of the spinal cord (Christopher et al, 2015).

The spontaneous course of myelopathy is characterised either by long periods of stable disability followed by episodes of deterioration or a linear progressive course. The presentation of cervical myelopathy varies in accordance with the severity of the spinal cord compression as well as its location.