Patient Feature: Warren’s Story

Warren is a 68‑year‑old retiree who recently decided to stay active by exercising more regularly. Over several weeks, he noticed something unusual — he struggled to walk in a straight line and often veered to one side without realising it. Daily tasks also became unexpectedly difficult. He took longer to put on his shirt, and his wife observed that he was fumbling with buttons and even having trouble using chopsticks.

Alarmed by his rapid deterioration, Warren’s wife brought him to their GP. Recognising the seriousness of his symptoms, the GP referred him promptly to a spine specialist. After clinical assessment and imaging, Warren was diagnosed with cervical myelopathy — a condition where spinal cord compression leads to progressive loss of hand coordination, balance, and fine motor skills.

Warren’s story highlights the importance of early recognition and timely specialist evaluation, especially when symptoms evolve quickly.

What Are the Symptoms?

• Neck stiffness, tightness, or discomfort
• Hand clumsiness or difficulty with fine motor tasks (e.g., buttoning, writing)
• Unsteady gait, balance problems, or a tendency to trip
• Weakness, numbness, or reduced coordination in the arms or hands
• Spasticity, increased muscle tone, or exaggerated reflexes

What Are the Risk Factors?

• Age above 50 (age-related degenerative changes)
• Congenital narrowing of the cervical spinal canal
• Ossification of the posterior longitudinal ligament (OPLL)
• Previous neck trauma, instability, or repetitive strain
• Asian ethnicity (higher prevalence of OPLL)
• Conditions associated with skeletal dysplasia

What Causes Cervical Myelopathy?

• Degenerative cervical spinal stenosis
• Disc herniation or disc bulging compressing the spinal cord
• Bone spurs (osteophytes) narrowing the spinal canal
• OPLL causing progressive pressure on the spinal cord
• Trauma, instability, or ligamentous thickening

How Is It Diagnosed?

• Neurological examination (e.g., Hoffman’s sign, gait assessment, reflex testing)
• MRI of the cervical spine to evaluate spinal cord compression
• CT scan to assess bony narrowing or OPLL
• Electrophysiological studies when diagnostic clarification is needed

What Are the Treatment Options?

Non-Surgical Management

• Activity modification and fall‑risk reduction
• Physiotherapy focusing on balance, coordination, and gait stability
• Medications to address spasticity or inflammation

Surgical Intervention

• Anterior cervical discectomy and fusion (ACDF)
• Posterior cervical decompression and fusion
• Laminoplasty (motion‑preserving decompression)

Conclusion

Cervical myelopathy is a serious and progressive condition that can affect mobility, hand function, and overall independence. At The Scoliosis & Spine Clinic (SG), we provide careful assessment and evidence‑based management for individuals with suspected spinal cord compression. Early recognition and timely evaluation are important to protect spinal cord function and support long‑term quality of life.

Frequently Asked Questions: Cervical Myelopathy

1. What are the common causes of medical myelopathy where surgery is not needed?
Medical myelopathy refers to spinal cord dysfunction caused by non‑mechanical or non‑compressive conditions. Examples include vitamin B12 deficiency, autoimmune disorders, viral infections, and inflammatory conditions such as multiple sclerosis. These cases are typically managed with medication, rehabilitation, and close monitoring rather than surgery.

2. What is stretch myelopathy?
Stretch myelopathy occurs when the spinal cord is elongated or placed under traction, often in the setting of spinal deformity or instability. It can lead to neurological symptoms even without direct compression.

3. What is the difference between medical myelopathy and surgical myelopathy?
Medical and surgical myelopathy differ in both cause and management approach.

Medical Myelopathy:

• Caused by systemic, metabolic, or inflammatory conditions
• Examples include vitamin deficiencies, autoimmune diseases, infections, or demyelinating disorders
• Managed with medication, rehabilitation, and regular follow‑up

Surgical Myelopathy:

• Caused by mechanical compression of the spinal cord
• Common causes include disc herniation, bone spurs, OPLL, or cervical spinal stenosis
• Often requires surgical decompression to prevent progressive neurological decline

4. What is the goal of surgery?
Surgery aims to relieve spinal cord compression, stabilise the spine when needed, and prevent further neurological deterioration. In many cases, timely decompression may help improve hand coordination, walking stability, and overall function.

5. What is the post‑operative recovery like?
Most patients are able to walk within a few days after surgery. Recovery typically includes physiotherapy, wound care, and a gradual return to daily activities. Neurological improvement varies between individuals and may take weeks to months, depending on the severity and duration of symptoms before surgery.

6. What affects the cost of surgery?
Costs depend on the type of procedure, hospital class, length of stay, and insurance coverage. During consultation, patients receive a clear breakdown of expected fees, and assistance is provided for financial counselling