Cervical Myelopathy

Cervical myelopathy is compression of the spinal cord itself in the neck — not just a nerve root, but the cord. The most common cause is age-related narrowing from disc disease, bone spurs, and ligament thickening, often layered on top of a congenitally narrow canal.

The cord doesn't cause pain the way nerves do. Instead, myelopathy presents with subtle signs: hand clumsiness, dropping things, difficulty with buttons or coins, balance problems, and a wide-based gait. People notice these gradually and often blame "aging." By the time we see them, symptoms may have been progressing for months or years.

Examination findings are central — hyperreflexia, a Hoffmann's sign, gait instability, intrinsic-hand weakness. An MRI of the cervical spine confirms cord compression and identifies the responsible levels.

Myelopathy is one of the few spine diagnoses where I generally recommend not waiting. Once cord injury is present, conservative care does not reverse it, and progression — while not inevitable — is common.

The surgical question is not usually whether to operate but how. The decision between an anterior approach (ACDF, corpectomy) and a posterior approach (laminectomy, laminoplasty, posterior fusion) depends on which levels are involved, the alignment of your neck, and the specific anatomy on your imaging.

For most patients with confirmed myelopathy and progressive symptoms, surgery is the right next step. Waiting risks irreversible cord injury and worse long-term function.

The goal of surgery isn't to fix what's already lost — neurologic recovery is variable and depends on how long compression has been present. The goal is to halt progression and give the cord room to heal. Many patients gain back substantial function; some plateau where they were.