Myelopathy

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Overview

Duke experts offer advanced surgical options to treat compression of the spinal cord, referred to as myelopathy. It is most common in the neck (cervical myelopathy) and middle back (thoracic myelopathy). Our experts treat myelopathy as well as contributing spine conditions, like spinal stenosis, disc herniations, spine injuries, spine cancer, and others. Myelopathy progressively worsens without treatment, so it’s important to seek care right away. Once we understand your problems and goals, we can create a treatment plan that is tailor-made for you.

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Treatments for Myelopathy

Treatments Overview

It’s important to understand that pressure on your spinal cord doesn’t always cause pain. Instead, it can affect your hand strength, balance, handwriting, or your ability to perform fine motor tasks like putting on earrings or buttoning a shirt. Myelopathy may not be reversible, but treatment can slow or stop its progression. Unfortunately, we can’t predict when your symptoms may get worse. To preserve your current function, your doctor may suggest one of the treatments below.

Laminoplasty

Description

Laminoplasty treats cervical myelopathy with an incision through the back of the neck. It is a motion-sparing surgery, meaning it preserves your range of motion (as opposed to spinal fusion surgery, which may restrict motion). It relieves pressure on the spinal cord and provides extra space for it by altering the lamina (bone that forms a roof for the spinal canal). A hinge is created on one side of the bone, while the other side is propped up and secured with metal plates. This surgery typically takes two to four hours and may require a few days’ stay in the hospital. Your doctor will determine whether laminoplasty is an option for you.

Total Disc Replacement (TDR)

Description

TDR removes the disc in the front of the neck and replaces it with an artificial disc. This motion-preserving procedure is usually reserved for when one or two discs are affected due to soft disc herniation. It may decrease the chances of needing additional surgery in the future.

Spinal Fusion Surgery

Description

For cervical myelopathy, there are two approaches to spinal fusion surgery:

The first is called anterior cervical discectomy and fusion (or ACDF). A surgeon makes an incision on the front of your neck to access the spine. The disc is removed and a graft or spacer is inserted in its place. The goal is for the bones above and below the spacer to fuse together.
The second is called a laminectomy with fusion. A surgeon makes an incision in the back of the neck, places rods and screws to stabilize the spine, and removes the lamina. This gives your spinal cord more space and relieves pressure.

Similar spinal fusion surgery approaches can also treat thoracic myelopathy -- when the pressure on your spinal cord occurs in your mid-back.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Tests for Myelopathy

X-Ray

Description

X-rays take pictures of bones and joints in your back. They can help identify fractures, tumors, dislocations, bone spurs, instability, or other potential causes of symptoms. You may be asked to bend forward and backward during your X-ray to evaluate instability or abnormal motion. Because X-rays only show bones, and not discs or nerves, an additional imaging test may also be needed.

Magnetic Resonance Imaging (MRI)

Description

Magnets and radio waves create detailed pictures of your spine, including your discs, nerves, and spinal cord. Images can help identify disc damage, pinched nerves, or spinal cord compression.

Computed Tomography (CT)

Description

A series of cross-sectional pictures produce detailed, 3D images of your spine.

CT Myelogram

Description

A dye is injected into the sac around the nerve roots in your spinal cord to make them more visible on a CT scan. This test is often used for people who are unable to get an MRI. You will feel some discomfort during the injection. This test takes about one or two hours.

Electromyogram (EMG) / Nerve Conduction Study (NCS)

Description

Electrodes are inserted directly into muscle with a thin needle to record electrical activity. You will feel some discomfort. EMG and NCS, which can last from 30 to 90 minutes, measure how well muscles and nerve cells are working in a certain area of your body -- in this case, your back or neck.

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Why Choose Duke

Highly Experienced Spine Center
Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. Our surgical team performs more than 3,000 spine surgeries every year and sees over 30,000 patients.

Surgical Experience
Surgery for myelopathy can be very challenging because it involves such a tiny, delicate area. These surgeries are commonly done using a surgical microscope and involve removing bone spurs, disc material, and scar tissue surrounding the nerve roots or spinal cord. Choosing highly specialized spine surgeons with advanced training, experience, and skill means you may have better, safer outcomes.

Minimally Invasive Spine Surgeries
Whenever possible, we use advanced minimally invasive procedures. Using high-powered microscopes and tiny instruments, surgeons can access the spine through small incisions. This technique limits muscle damage, results in less pain, and helps you recover faster.

Operating Room Technology
Our ORs are equipped with real-time imaging options that give spine surgeons detailed, 3D pictures and video of your spine. These systems help decrease the need for extra imaging after surgery, exposing you to less radiation. OR staff also use a sophisticated sensor navigation system that helps them avoid vital nerves and other structures. This allows for more surgical accuracy than ever before.

Team of Specialists
In addition to neurosurgeons and orthopaedic surgeons, your team may include physiatrists (physical medicine and rehabilitation doctors who specialize in conservative spine care), physical therapists, psychologists, pain management experts, and others -- all of whom work with you to alleviate the symptoms caused by your myelopathy.

Best Hospital for Orthopaedics, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics, neurology, and neurosurgery programs are nationally ranked, and are the highest ranked programs in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 11/02/2022 by

William J. Richardson, MD | Orthopaedic Surgeon