Zervikale Myelopathie

Cervical myelopathy means the spinal cord in the neck is being squeezed, leading to problems with hand control, walking, balance, and sometimes bladder or bowel function. It usually develops slowly over time from age‑related changes, but once symptoms appear, they tend to progress without effective treatment.​

1) What is this condition?

  • The main nerve “cable” (spinal cord) running through the neck is compressed by disc bulges, bone spurs, thickened ligaments, or other growths.​

  • Typical symptoms include hand clumsiness, trouble with buttons or handwriting, stiffness and weakness in the legs, unsteady walking, frequent falls, and sometimes bladder/bowel changes.​

2) How serious is it?

  • This is considered a potentially serious condition because ongoing pressure can cause permanent damage to the spinal cord.​

  • Without adequate treatment, many patients slowly worsen over time, with increasing difficulty walking and using their hands, and higher risk of falls and disability.​

3) Non‑surgical treatments

  • Activity and posture adjustment: avoiding high‑risk neck motions, heavy lifting, and falls; using canes or walkers if balance is affected.​

  • Medicines: pain relievers and anti‑inflammatory drugs can help neck and arm pain but do not remove pressure from the cord.​

  • Physical therapy: gentle strengthening, balance and gait training, and safety strategies; used with great caution to avoid worsening cord compression.​

  • Close monitoring: non‑operative care is sometimes reasonable for mild, stable cases, with frequent checks for any sign of deterioration.​

4) Possible surgery

  • Front‑of‑neck (anterior) options:

    • Anterior cervical discectomy and fusion (ACDF) or corpectomy (removing one or more vertebral bodies) to remove pressure from the front and then fuse.​

  • Back‑of‑neck (posterior) options:

    • Laminectomy with or without fusion, or laminoplasty, to open the spinal canal from behind over several levels.​

  • The specific choice depends on how many levels are tight, neck alignment, and the patient’s overall health.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Manage pain and protect safety in milder or higher‑risk patients, while monitoring closely for any sign of worsening nerve or cord function.​

  • Surgery goals:

    • Free the spinal cord from pressure, stop further neurologic decline, and, when possible, improve walking, hand function, and balance.​

6) How surgery can fix the problem

  • Anterior surgery removes discs, bone spurs, or entire vertebral bodies pressing the cord from the front, then uses a graft/cage and plate to keep the spine open and stable while bone grows across (fusion).​

  • Posterior surgery removes or reshapes the “roof” of the canal so the cord has more room and can drift away from pressure, often combined with rods and screws if several levels are unstable.​

7) Risks of surgery (general and specific)

  • General: infection, bleeding, blood clots, and anesthesia‑related heart or lung issues, especially in older or medically complex patients.​

  • Anterior‑specific: swallowing trouble, hoarseness or voice changes, injury to the food pipe or windpipe, and graft or hardware issues.​

  • Posterior‑specific: higher rates of wound problems, infection, neck muscle pain, and specific nerve palsy (for example, C5 weakness in the shoulder).​

  • Rare but serious: worsening of spinal cord function, including new weakness, numbness, or, very rarely, paralysis.​

8) Chances this surgery will work

  • In most patients, surgery improves or at least stabilizes neurologic function; multiple large studies show improvement in over 70–80% of appropriately selected patients.​

  • Earlier surgery (shorter duration of symptoms and less severe deficits) is linked to better outcomes and more meaningful recovery.​

9) Possible complications from the surgery

  • Worsening neurologic function can occur in a small minority, sometimes related to factors like reperfusion injury or technical complications.​

  • Structural issues such as non‑union (failed fusion), hardware problems, or breakdown at levels above or below the surgery may require additional operations.​

  • Persistent symptoms: some stiffness, numbness, or gait issues may remain, especially when the cord has been compressed for a long time.​

10) Typical recovery from the condition (without surgery)

  • Mild, stable myelopathy can sometimes be observed for years with careful monitoring and safety precautions.​

  • For many patients, especially with moderate or severe disease, non‑operative care carries a higher chance of neurologic progression than operative treatment.​

11) Typical recovery after surgery

  • Early phase (days–weeks): hospital care focuses on pain control, neck support, early walking, and prevention of blood clots; some patients notice early improvement in walking or hand use.​

  • Intermediate (weeks–months): ongoing physical and occupational therapy to work on balance, strength, and fine motor skills; recovery often continues for 6–12 months.​

  • Some limitations (stiffness, mild weakness, or numbness) are common long term, especially after multi‑level surgery or long‑standing compression.​

12) How long in the hospital

  • Many single‑ or two‑level decompressions require about 1–3 days in the hospital if there are no complications.​

  • More extensive multi‑level surgeries or patients with other serious health issues may need longer stays and possibly a short stay in a rehab facility.​

13) Long‑term outlook

  • With timely surgery, many patients achieve long‑term stabilization or improvement, though not always a complete return to normal.​

  • Longer delays before surgery, older age, and more severe pre‑operative symptoms are linked to less complete recovery and higher risk of residual disability.​

14) Need for outpatient follow‑up

  • Non‑surgical: regular follow‑ups to check walking, balance, hand dexterity, and bladder/bowel function; repeat imaging if symptoms change.​

  • Post‑surgery: scheduled visits for wound checks, neurologic exams, and imaging (especially when fusion is performed) to confirm healing and alignment.​

  • Long‑term: ongoing therapy, fall‑prevention strategies, and prompt reassessment if any new weakness, numbness, or bladder/bowel changes develop.