Cervical myelopathy
Spinal cord compression — Degenerative cervical myelopathy
What is cervical myelopathy?
Cervical spondylotic myelopathy (or degenerative cervical myelopathy) is a suffering of the spinal cord caused by its chronic compression at the level of the neck. It is mainly due to the effects of natural wear on the spine (arthritis, disc degeneration, ligament thickening).
It is the most common cause of spinal cord dysfunction in adults over 50. Unlike a typical disc herniation that compresses a single nerve, here it is the central nervous axis (the spinal cord) that is squeezed, which can disrupt nerve signals to the entire body (arms and legs).
How it develops
The narrowing of the canal where the cord passes results from several combined phenomena:
• Osteophytes: bony "parrot beak" spurs that encroach on the canal
• Disc wear: discs collapse or bulge (herniations), reducing the available space
• Ligament thickening: ligaments become thicker and less flexible
• Consequence: the cord suffers both direct mechanical pressure and reduced blood supply
Symptoms & Clinical signs
Signs are often subtle at first and may be mistaken for normal ageing, but they worsen in a stepwise fashion:
• Loss of dexterity: clumsiness of the hands, difficulty buttoning a shirt, writing or handling small objects
• Gait disturbance: feeling of "stiff" or "heavy" legs, loss of balance, unsteady walking
• Neurological signs: tingling in the hands, electric shock sensations down the back when bending the neck (Lhermitte's sign)
• Pain: neck pain may be present but is not always a feature
Diagnosis
• Clinical examination: looking for overactive reflexes (hyperreflexia) or signs of spasticity
• Cervical MRI (gold standard): shows the degree of compression and the appearance of a "signal change" within the cord
• CT scan: maps bony spurs (osteophytes) before potential surgery
Treatment
The primary goal is to halt neurological deterioration, as spinal cord cells recover poorly:
Observation & conservative management
• Only appropriate for very mild, stable forms
• Requires regular neurological follow-up to avoid missing progression
Surgical treatment (often essential)
• Goal: "free" the spinal cord by widening the canal (decompression)
• Relative urgency: not an immediate life-threatening emergency, but the longer surgery is delayed, the higher the risk of permanent damage
• Outcome: surgery is very effective at stopping disease progression; recovery depends on how long symptoms have been present
Key figures
50–70 years
Age range where the diagnosis is most common
80%
Stabilisation or improvement after decompression surgery
Leading cause
Of motor disability from spinal cord origin in older adults
Recovery after surgery
After cervical decompression surgery, the hospital stay averages 3 to 7 days. Patients are encouraged to stand the day after the operation. A cervical collar may be prescribed for a few weeks depending on the surgical approach and the number of levels operated on. With the anterior approach, some swallowing discomfort is common in the first few days — this is temporary and resolves on its own.
Symptom improvement is gradual and unfolds over several months. Hand dexterity and walking balance are usually the first to improve. A rehabilitation programme is essential: targeted physiotherapy focusing on muscle strengthening, proprioception and fine motor recovery. The most significant gains occur within the first 3 to 6 months, but improvements continue to be seen for up to a year after surgery. Return to work depends on the type of activity and neurological status: between 6 weeks and 3 months for sedentary occupations.
Consultation with Dr Dimitriu
Dr Christian Dimitriu, a neurosurgeon specialising in cervical spine surgery, manages cervical myelopathy at all stages. During the consultation, he performs a meticulous neurological examination: gait assessment, hyperreflexia testing, hand dexterity evaluation (Hoffman's test, Babinski sign), balance and muscle strength assessment.
The cervical MRI is analysed in detail to evaluate the degree of cord compression and the presence of a T2 signal change (a sign of cord suffering). Dr Dimitriu clearly explains what is at stake: without treatment, myelopathy inevitably worsens in a stepwise fashion, with an increasing risk of permanent disability. He discusses the most appropriate surgical strategy — anterior approach (discectomy + cage) or posterior approach (laminoplasty, laminectomy) — based on the number of levels involved, the type of compression and the patient's cervical curvature.
Prevention and monitoring
Cervical myelopathy cannot be "prevented" as such, since it results from the natural ageing of the cervical spine. However, early diagnosis is essential to optimise the chances of recovery. Anyone over 50 experiencing dexterity problems, walking difficulties or tingling in the hands should seek medical advice promptly.
Patients in whom cervical canal narrowing has been identified on imaging should have regular neurological follow-up to detect the earliest signs of cord suffering. It is advisable to avoid sudden cervical movements and activities that carry a risk of neck trauma (violent contact sports, diving). Maintaining good cervical musculature through gentle, regular exercises helps protect the cervical spine and preserve mobility.
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
Surgery can halt disease progression in approximately 80% of cases and achieve significant improvement in many patients. However, damage already sustained by the spinal cord only partially recovers. This is why early diagnosis and treatment are essential: the sooner surgery is performed, the better the prognosis for recovery.
The operation can be performed from the front (anterior approach) or the back (posterior approach) depending on the number of levels involved and the type of compression. Via the anterior approach, the surgeon removes the compressive discs or osteophytes and inserts fusion cages. Via the posterior approach, the canal is widened by opening the vertebral laminae (laminoplasty) or removing them (laminectomy). The operation takes 1 to 3 hours under general anaesthesia.
As with any surgery, there are rare but real risks: infection, haematoma, nerve or cord injury, temporary swallowing difficulty (anterior approach). However, the main risk is NOT operating: without decompression, myelopathy inevitably worsens in a stepwise fashion, with an increasing risk of permanent disability. The benefit of surgery far outweighs the risks in the vast majority of cases.
The hospital stay lasts 3 to 7 days. Symptom improvement is often gradual over several months. Hand dexterity and balance tend to improve first. Rehabilitation plays an important role in recovery. The most significant gains occur within the first 3 to 6 months, but improvements can continue for up to a year after surgery.
Sources: The Lancet (Badhiwala et al. 2020) · StatPearls (2024) · Global Spine Journal (Fehlings et al.).