myelopathy

Myelopathy is any disorder causing dysfunction of the spinal cord, regardless of the cause or location along the spine. It is a descriptive term used when the spinal cord is affected by compressive, inflammatory, ischemic, infectious, metabolic, or traumatic processes. The term myelopathy is broader than myelitis, which refers specifically to inflammation of the spinal cord; myelopathy may result from noninflammatory lesions such as compression or vascular injury.

Common etiologies include degenerative cervical spondylotic myelopathy (CSM), traumatic spinal cord injury, spinal tumors, epidural abscess, vascular causes (ischemic myelopathy or spinal cord infarction), metabolic deficiencies (e.g., vitamin B12 deficiency causing subacute combined degeneration), inflammatory/demyelinating diseases (such as multiple sclerosis–related myelopathy), and autoimmune disorders.

Symptoms depend on the level and mechanism; they often include symmetric or asymmetric weakness below the lesion with upper motor neuron signs in the legs (spastic gait, hyperreflexia, Babinski), sensory disturbances (numbness, paresthesias, band-like dissociated sensory loss), gait imbalance, and hand clumsiness. Autonomic symptoms such as urinary or bowel dysfunction can occur. Lhermitte sign may be present in cervical myelopathy.

Evaluation begins with neurological examination and MRI of the spine, which is the preferred modality for identifying compressive lesions and cord signal changes. CT or myelography may be used if MRI is unavailable. Additional tests may include plain radiographs, blood tests for nutritional or inflammatory etiologies, and, when appropriate, electrophysiology or CSF analysis.

Management depends on the cause. Cervical compressive myelopathy often requires surgical decompression with or without stabilization; acute spinal cord compression due to infection, abscess, or fracture is an emergency. Medical therapy targets the underlying disease (antibiotics for infection, steroids or disease-modifying therapies for inflammatory causes, B12 replacement for deficiency, cancer treatment for neoplastic causes). Rehabilitation and physical therapy are important for functional recovery. Prognosis varies with severity, duration of symptoms, and promptness of treatment; earlier decompression yields better outcomes in compressive etiologies.