Comprehensive Myelopathy – Spinal Cord Surgery
Myelopathy is a condition where there is loss of spinal cord activity due to trauma or degeneration of the spine. The aim of the surgery is to relieve symptoms of pressure on the spinal cord or decompressing. Surgery is recommended when the nonsurgical treatments no longer work and the disorder progresses to swelling in the spinal cord along with neurological changes like:
- Weakening of arms and legs
- Numbed hands
- Gait changes
- Difficulties in motor skills
The spine consists of the bone, ligaments, joints, and muscles. The spinal cord is a collection of never fibres connected to the brain and the brain stem serving to effectively communicate the function between the brain and the body.
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Types of Myelopathy
- Cervical Myelopathy– The most common form of Myelopathy, it occurs in the neck.
- Thoracic Myelopathy– It occurs in the middle area of the spine. The spinal cord gets compressed due to bulging or herniated discs, spinal trauma or bone spurs.
- Lumbar Myelopathy– A rare condition where the spinal cord is low lying or tethered unlike a normal spinal cord that ends in the top part of the lumbar spine.
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Causes of Myelopathy
With age, our spines lose its water content and the years of use begins to reflect resulting in pressure being placed on the spine. Besides age-related spine degeneration, several factors cause Myelopathy such as:
- Bone spurs
- Tumours that could be benign compressing the spinal cord
- Trauma like motor accident or sport injury
- A fracture that is dislocated
- Autoimmune diseases
- Congenital abnormality
Other factors that could increase the risk of Myelopathy are:
- Alcohol abuse
- Lack of exercise
- Involving in intense sports like football or gymnastics
- Repetitive and strenuous movement like physical labour
- Heavy objects being lifted improperly
Symptoms of Myelopathy
The symptoms depend on the location and severity of the spinal problems. Symptoms will increase and intensify over time. Some of the symptoms are:
- Trouble balancing
- Pain in the shoulders and arms
- Sensations like tingling, pins and needles or numbness in the arms and legs
- Feeling of heaviness in the legs and inability to move quickly
- Difficulty writing
- Muscle weakening
- Trouble with bending or turning with neck or back
- Irregular spasmodic movements
- Problem with hand-eye coordination
- Changes in sexual functioning
- Bowel or bladder complications
- Fatigue or frailty in the limbs
- Feeling of shocked or electrified limbs
- Physical examination of the spine and body
- MRI Scan
- CT Scan
- Electromyogram or somatosensory evoked potentials
Treatment of Myelopathy
Treatment depends on the causes. Due to the nature of the cause, some treatment may only be able to relieve the symptoms or slow down the progressive degeneration of the disorder. There are two types of treatment:
- Nonsurgical Myelopathy Treatment- treatments include physical therapy, medication, and bracing. It is usually meant for mild Myelopathy that aims to reduce pain and get back to normal physical activities. Since this does not remove compression, symptoms will progress gradually and can be quite acute in some cases. Some Myelopathy is irreversible even after treatment, so it is important to detect early and slow progression while it is found to be mild.
- Surgical Myelopathy Treatment– to relieve pressure on the spinal cord, surgery is a common procedure. Bone spurs or herniated discs may also be removed if they are the cause of Myelopathy. Several surgical procedures are available for those with progressive neurologic change with signs of severe spinal cord compression or spinal cord swelling or those with severe or disabling pain. Minimally invasive procedure may often be a better choice than open surgery owing to the fact that it has a lower risk for complications and faster recovery.
- A complete physical examination of your body.
- Taking diagnostic tests.
- Inform your doctor of all your medical history including allergies and medications.
- The type of surgery depends on your overall health, type and location of the problem.
- Your doctor will discuss the best procedure for you.
- You will be asked to stop smoking if you currently do.
- If overweight, you will be asked to shed some pounds.
- You may be asked to do a combination of exercises.
- Lifestyle changes on eating and living healthy may be prescribed.
- You may need to undergo hot and cold treatments, injections.
- If oral medications are given, you will need to take them exactly as prescribed.
- You will need to fast 8 – 12 hours before surgery.
- You will be given general anaesthesia so that you will not feel any pain.
- The surgeon makes an incision into the affected area.
- Depending on the type of Myelopathy, the surgeon will perform either a front or back of the neck approach or both may be necessary in some cases.
- A spinal fusion may be done wherein a bone graft is used to fuse together the vertebrae.
- In some cases, a “cage” may be used to allow spinal fusion between two vertebrae for stability along with screws and rods.
- Laminectomy procedure may be carried out to remove bony arch at the back of the spinal canal along with bone spurs and ligaments that compresses the spinal cord.
- A bone graft may follow this procedure.
- Laminoplasty is an alternative procedure wherein the sides of the spinal canal are thinned out on one side and then cut on the other side to create a hinge expanding space for the spinal cord.
- The incision is closed and dressing is done on the area.
- Typical hospital stay is for a day or two. However, the length depends on the recovery process of the patient.
- Depending on the procedure, a drain may be attached to your spine to collect any blood or fluid after surgery.
- You may have difficulty swallowing some food for several days. Having soft food that are easy to swallow post operation will be helpful.
- You may also have a hoarse voice depending on the type of surgery.
- You may need to wear a soft or rigid collar for some time.
- You may be given medication if you experience any pain.
- Your surgeon may recommend a therapist.
Risks and Complications
As with all surgeries, this comprehensive surgery is not without complications or risks. Some possible repercussions are:
- Nerve injury
- Spinal injury
- Oesophagus injury
- Difficulty breathing
- Degeneration of disc levels above or below the surgery
- Complications relating to bone graft and spinal fusion
- Injury to vertebral artery
- Wound breakdown
Factors affecting the cost of Myelopathy Spine Surgery
The cost of Myelopathy starts from $6500. Factors that affect the cost include:
- Location of the hospital
- Choice of hospital
- Type of procedure
- Surgeon’s fee
- Diagnostic tests
- Duration of stay