Spinal Cord Compression (Myelopathy): When the Spine Squeezes the Spinal Cord

Cervical myelopathy — compression of the spinal cord itself within the cervical spine (neck) — is one of the most common causes of spinal cord dysfunction in adults over 50, yet it is frequently under-diagnosed or misattributed to "normal ageing." Unlike radiculopathy (nerve root compression causing arm pain), myelopathy compresses the spinal cord, producing symptoms below the level of compression — in the hands, trunk, and legs — often without neck pain at all.

Causes

The spinal canal becomes narrowed (stenotic) due to: cervical spondylosis — degenerative disc disease with osteophyte formation; disc herniation; hypertrophy of the ligamentum flavum (the ligament behind the cord); congenitally narrow spinal canal (a risk factor for myelopathy developing at a younger age with less degeneration); OPLL (ossification of the posterior longitudinal ligament — more common in East and South Asian populations).

Clinical Features — The Myelopathic Pattern

Hands: clumsy, difficulty with fine motor tasks (buttoning shirts, writing, using chopsticks — the "myelopathic hand"); intrinsic muscle wasting; the "finger escape sign" (the little finger spontaneously drifts outward when the patient tries to hold all fingers extended and together). Legs: stiff, spastic gait; difficulty climbing stairs; sense of heaviness; may have "electric shock" sensation shooting down the spine and into the legs with neck flexion (Lhermitte's sign). Bladder: urgency and frequency. Reflexes: brisk throughout with Babinski sign.

Treatment — Why Timing Matters

Myelopathy is generally progressive — though the rate is variable. Neurological deficits that develop from myelopathy are partially reversible if decompressive surgery is performed before cord damage becomes severe and irreversible. The surgical window is critical: patients with moderate disability who are operated on in time typically stabilise or improve; those who wait until severe disability often do not recover function even after cord decompression. MRI cervical spine is the diagnostic test. Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.