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Abstract

Cervical myelopathy is a sequence of alterations that cause etiological ailments such as spondylosis, ossification of the posterior longitudinal ligament, and compression of nerve roots at various levels. The reduced diameter of the vertebral canal is because of degenerative changes in the structure of the disc, along with the formation of osteophytic spurs that compress the surrounding structures, such as nerve roots, at one or more levels. Radiography, CT, MRI, and dynamic study help identify cervical spondylotic myelopathy. Surgical methods such as anterior, posterior, or combined approaches are used to stabilize and potentially improve the subject’s neurologic status. The spine’s alignment, the number of mobility segments implicated, the morphology, and the location of the spondylotic compression guide surgical decision-making. Cervical spondylotic myelopathy is a condition of the cervical spine that causes narrowing of the spinal canal with symptoms such as neck pain, numbness in the hands, gait problems, and sphincter dysfunction. We present the case of a 52-year-old male diagnosed with compressive myelopathy from C3 to C7 with a history of falling from the bed. On MRI, there were degenerative changes, spondylosis, and compressive myelopathy, and a disc bulge at multiple levels was seen. The patient underwent a spinal fusion at C3 to C7 level followed by structured physical therapy rehabilitation to gain a good recovery and functional independence to improve quality of life.

Introduction

Cervical spondylotic myelopathy, or degenerative cervical myelopathy, is a common serious neurological disorder in adults. The etiology of the condition could be compression at the spinal cord level. Common symptoms include neck pain, functional limitation, and motor functions in arms, fingers, and hands. If the patient does not take proper treatment, it could lead to permanent nerve damage and paralysis [1]. Posterior decompression enlarges the space needed for the spinal cord and permits the cord to move backward from the front structure. The benefits of the posterior approach include the decompression of nerve under imagination and prevention of injury to anterior structures along with some major vessels, the esophagus, and recurrent laryngeal nerve [2].

Static and dynamic stressors can lead to degenerative cervical myelopathy. There is stenosis of the developmental canal, intervertebral disc bulging, along with hypertrophy of ligamentum flavum. Dynamic stressors include the invagination of the ligamentum flavum [3]. Posterior decompression and fusion and laminoplasty are used to treat cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament [4]. In the surgical method of posterior decompression in spondylotic myelopathy of the spine, a recovery rate of 30% to 55% has been reported [5]. Overall, 21% of cervical myelopathy patients fail to exhibit any myelopathic indications, indicating that myelopathic symptoms were not very sensitive in detecting the existence of cervical myelopathy [6]. The pathophysiology of degenerative compression is apoptosis of cellular structures, vascular changes, inflammatory responses, axon degeneration, and myelin changes. Wallerian degeneration in the white matter of motor axons in the lateral corticospinal tract leads to clinical symptoms such as spastic gait [7].

In patients with anterior cervical decompression, strength increases by 80 to 90% in each muscle group. Patients feel functional improvements in their lower extremities; sometimes, there is a discrepancy due to prolonged spasticity rather than muscle weakness [8]. The etiology of the condition could be due to spinal cord dysfunction among adults aged 55 years, along with risk factors causing traumatic central cord syndrome, the most common cause of cervical spinal cord injury [9]. Assessment findings include stiffness in the neck region, a wide-base ataxic gait, ascending paraesthesia in both extremities, lower extremity weakness, reduced hand dexterity, hyperreflexia, clonus, Babinski sign, and bowel or bladder dysfunction [10]. In all, cervical myelopathy is diagnosed in 18.1% of patients nationwide receiving cervical decompression myelopathy. Compared to individuals without myelopathy, patients receiving cervical decompression myelopathy are more likely to be...(More)

For more info please read, The Scope of Physiotherapy Rehabilitation in Compressive Myelopathy Managed by Spinal Fusion: A Case Report, by Cureus