More specifically, they are cervical myelopathies: cervical spinal stenosis, cervical myelitis, all lesions of the cervical spinal cord of traumatic origin and diseases of the blood vessels that nourish the cervical tract of the spinal cord.
Cervical myelopathy can be associated with a number of symptoms, including neck pain, shoulder pain, loss of fine motor skills, muscle weakness in the limbs, and paraesthesia.
The triggering cause and the severity of the symptoms influence the choice of therapy adopted in the presence of cervical myelopathy.
What is the Spinal Cord: a brief review
The spinal cord is, together with the brain, one of the two fundamental components of the central nervous system.
Structurally very complex, this vital nervous organ has several groups of neurons (organized in white matter and gray matter) and 31 pairs of nerves (the so-called spinal nerves), and has the important task of sorting the incoming and outgoing signals between the different brain areas (lobes of the brain, cerebellum, etc.) and the rest of the organism.
In order to receive the right protection, the spinal cord takes its place inside the so-called spinal canal, that is the duct resulting from the overlapping of the vertebrae of the spinal column and their characteristic holes.
For further information: Spinal Cord: Anatomy and Functions ).
Cervical Myelopathies: What Are They in the Details?
In the "list of cervical myelopathies, there are:
- All episodes of spinal-cervical stenosis;
- Forms of myelitis (ie inflammation of the spinal cord) with a cervical site;
- Injuries of the cervical spinal cord of traumatic origin (cervical spinal lesions or cervical myelic lesions);
- Vascular diseases related to the cervical tract of the spinal cord (cervical vascular myelopathies).
What is the most common cervical myelopathy?
The most common and (precisely because common) interesting cervical myelopathy is cervical spinal stenosis.
Cervical spinal stenosis is a pathology of the "cervical spine - cervical spinal cord" complex, characterized by narrowing of the spinal canal and, consequently, by acute or chronic (depending on the cause) compression of the spinal cord.
Origin of the term "Cervical Myelopathy"
- The term "myelopathy" derives from the "union between the word" honey ", which in medicine refers to the spinal cord, and the word" patia ", which means" disease ".
- The term "cervical", on the other hand, refers to the region of the neck, that is the anatomical department of the human body along which the cervical tract of the vertebral column and the spinal cord pass (NB: "cervical" can also refer to the neck of the uterus; however , it is unlikely to get confused, as the context always and immediately clarifies the precise scope of discussion).
From this etymological analysis it appears that the literal meaning of "cervical myelopathy" is "disease of the cervical spinal cord".
;Cervical spondylosis
Spondylosis corresponds to arthrosis of the spine; consequently, cervical spondylosis is arthrosis of the cervical spine.
The clinical peculiarity of this widespread medical condition is the gradual degeneration of the cervical vertebrae (to be precise, the bodies of these vertebrae), degeneration that alters the morphology of the cervical spinal canal (i.e. the spinal canal of the cervical spine).
Favored by factors such as old age, obesity and a history of neck trauma, cervical spondylosis is the leading cause of cervical spinal stenosis.
Cervical Spinal Tumor
Cervical spinal tumors are clusters of abnormal cells ("crazed" cells) located in the cervical spine.
Cervical spinal tumors (and spinal tumors in general) cause spinal stenosis, because, with their mass (which is constantly increasing due to the hyperproliferation typical of neoplastic processes), they take away the space reserved for it from the spinal cord.
Rheumatoid arthritis
Rheumatoid arthritis is a degenerative joint disease which, when it affects the cervical spine, has similar effects to cervical spondylosis.
According to the reliable opinion of doctors, rheumatoid arthritis is an autoimmune disease.
Cervical Disc Herniation (or Cervical Hernia)
In medicine, the term "cervical disc herniation" indicates the exit of the nucleus pulposus of one of the cervical intervertebral discs in the direction of the adjacent nerve structures (eg: adjacent spinal cord) or in the direction of the nearest vertebral bodies.
Cervical disc herniation causes spinal stenosis, when the nucleus pulposus invades, following its release, the space reserved for the spinal cord located in the immediate vicinity.
For further information: Cervical Hernia: What "is in the detailsCongenital malformation of the cervical spine
From birth, in some individuals, the spinal canal along the cervical spine is narrower than normal.
The presence from birth of a narrowing of the spinal canal (be it along the cervical tract or in "another section of the spine) is an example of congenital spinal stenosis.
Did you know that ...
When cervical spinal stenosis is due to cervical spondylosis, doctors also speak of cervical spondylotic myelopathy or spondylenic cervical myelopathy.
Causes of Cervical Myelitis
Myelitis is the medical condition that results from inflammation of the gray or white matter of the spinal cord; when accompanied by the term "cervical", it simply means that the inflammatory process affects the cervical tract of the spinal cord.
Myelitis recognizes numerous causes; in fact, it can depend on viral infections (eg: poliomyelitis, AIDS, varicella virus, herpes zoster or West Nile virus), bacterial infections (eg: tuberculosis, syphilis, meningitis or Lyme disease), fungal infections (eg: Cryptococcus neoformans, Coccidioides immitis or Blastomyces dermatitidis), parasitic infections (ex: Schistosoma, Taenia solium or Trichinella spiralis), autoimmune diseases (eg: optic neuromyelitis, Sjögren's syndrome, multiple sclerosis or systemic lupus erythematosus) and even some vaccines (eg: for hepatitis B, for measles, mumps and rubella, and for diphtheria and tetanus).
The inflammation induced by myelitis affects the functioning of the spinal cord; this is due to the damage that the aforementioned inflammation causes to the neurons of the gray and white matter of the affected spinal cord.
Causes of Traumatic Cervical Spinal Injuries
Injuries of the cervical spinal cord of traumatic origin are the consequence of serious trauma to the cervical tract of the spine, which subject the latter to abnormal movements (eg: hyperflexion, hyperextension, rotation and lateral sliding) or that undermine its integrity ( cause the fracture of a vertebral body, the resulting fragments of which injure the spinal cord).
Among the most frequent causes of such trauma to the spine, there are: motorcycle and car accidents, accidental falls on the back (eg falls from a horse), acts of physical violence and more (eg: gunshot wounds ) and neck injuries resulting from the practice of contact sports such as rugby or American football.
Causes of Cervical Vascular Myelopathy
By "cervical vascular myelopathy" doctors mean a more or less severe suffering of the cervical spinal cord, due to an "alteration in the supply of oxygenated blood to the latter" (oxygenated blood is essential for the survival of any tissue and organ of the human body, including the spinal cord).
The medical conditions that can cause cervical vascular myelopathy include: atherosclerosis (due to its occlusive phenomena), diabetes-induced angiopathy, hematomyelia (internal hemorrhage in the spinal cord), aortic dissection , polyarteritis nodosa (consists of an "inflammation of the arterial vessels with harmful effects), the aforementioned systemic lupus erythematosus, neurosyphilis and medullary ischemic phenomena (eg: medullary TIA).
When severe, cervical vascular myelopathy can affect the blood supply to the cervical spinal cord so severely that it causes death from necrosis of the nerve organ (example of a spinal cord infarction).
Risk Factors of Cervical Myelopathies
Factors such as:
- Infections dangerous to the health of the spinal cord (eg polio);
- The abnormal blood supply to the spinal cord (due, for example, to the presence of atherosclerosis);
- The presence of an autoimmune disease, such as systemic lupus erythematosus, Sjögren's syndrome, multiple sclerosis, or optic neuromyelitis;
- The presence of a past history of neck trauma (because they are risk factors for cervical spondylosis);
- The presence of a congenital spinal stenosis with cervical site;
- The practice of sports or work that is hazardous to the health of the spine;
- The appearance of a cervical spinal tumor.
Cervical Myelopathy: Complications
In the absence of adequate therapy or if very severe, cervical myelopathies are diseases that can give rise to complications; Specifically, among these complications, the following deserve mention: the chronicization of painful sensations, the increasingly frequent recurrence of muscle spasms, total paralysis of the upper and lower limbs, total loss of control of urinary and fecal functions, the onset of sexual dysfunction (erectile dysfunction for men and anorgasm for women), depression resulting from having to live with previous complications and, finally, the onset of serious and potentially fatal cardiovascular problems.
The most serious cervical myelopathies are those in which the spinal cord develops a lesion affecting its nerve cells. The lesions affecting the nerve cells of the spinal cord (as well as the lesions affecting the nerve cells of the brain) are irreversible alterations, which cannot be cured in any way.
, physical examination, a thorough neurological examination, radiological tests such as myelography, nuclear magnetic resonance imaging of the spine and CT of the spine, blood tests and lumbar puncture.
In addition to providing numerous data on the present condition, such a meticulous diagnostic procedure allows, in uncertain cases, to exclude, step by step, pathologies with similar symptoms, but not associated with spinal cord suffering (differential diagnosis).
Why is Diagnosis of the Causes of Cervical Myelopathy important?
The knowledge of the causes of a cervical myelopathy is very important, because it is on the causal factors that the planning of the most adequate therapy depends.
and adoption of a healthy lifestyle) and, for the most severe cases, in surgical treatment aimed at relieving compression of the spinal cord (spinal decompression surgery).Cervical stenosis due to Spinal Tumor
If cervical myelopathy is cervical spinal stenosis resulting from a tumor of the spine (spinal cancer), treatment will consist of surgery to remove the tumor.
Autoimmune myelitis
If cervical myelopathy is an autoimmune myelitis, treatment will include administration of corticosteroids and immunosuppressants, in order to alleviate the inflammation present and mitigate the improper response of the immune system (which is the causative factor of the aforementioned inflammation).
Spinal Cervical Injury of Traumatic Origin
If cervical myelopathy is a traumatic cervical spinal injury, the therapy will include immobilization, the intravenous administration of a highly anti-inflammatory corticosteroid, whose name is methylprednisolone, and a "surgical operation on the spine aimed at eliminating any anomalies that occurred as a result of the trauma (eg: in the presence of a vertebral fracture, the surgery is used to remove any bone fragments of the fractured vertebra).
