Myelopathy: Symptoms, Types, Causes and Treatment

Myelopathy is a serious neurological disorder that results from damage to the spinal cord. This condition can have a profound impact on a person’s quality of life, affecting movement, sensation, and even bodily functions such as bladder control. Understanding myelopathy—its symptoms, types, causes, and treatment options—is essential for timely diagnosis and effective management. In this article, we’ll break down everything you need to know about myelopathy using insights from recent clinical research.

Symptoms of Myelopathy

Myelopathy often develops gradually, making early signs easy to overlook. Recognizing these symptoms early is crucial, as untreated myelopathy can lead to permanent neurological deficits. Below, we’ll explore the typical symptoms and how they manifest.

Symptom	Description	Body Region(s) Affected	Source(s)
Pain	Localized over lesion, sometimes girdle-like	Back, trunk	1, 2
Motor Issues	Weakness, clumsiness, paralysis, fatigability	Arms, legs	1, 3
Sensory Changes	Numbness, paresthesia, deadness, dysesthesias	Trunk, limbs	1, 3
Gait Disturbance	Unsteady walking, difficulty with balance	Legs, trunk	2, 7
Autonomic Dysfunction	Bladder and bowel problems	Pelvic organs	1, 3

Table 1: Key Symptoms

Pain: The Initial Red Flag

Pain is often the first sign, typically localized to the area of the spinal cord affected. It can present as a dull ache or as sharp, girdle-like pain wrapping around the trunk. In thoracic myelopathy, back or low back pain is common and may be accompanied by girdle pain, especially with upper or lower spinal involvement 1, 2.

Motor Abnormalities

Motor symptoms are hallmark features. Patients may notice:

• Sudden or progressive weakness in arms or legs
• Clumsiness, especially in tasks requiring fine motor skills
• Fatigability or heaviness in limbs In severe cases, paralysis can develop rapidly or over weeks 1, 3.

Sensory Disturbances

Sensory symptoms often include:

• Numbness or tingling (paresthesias)
• Deadness or loss of sensation in affected areas
• Abnormal sensations (dysesthesias) These symptoms typically follow a pattern based on the spinal cord level involved 1, 3.

Gait and Balance Problems

Difficulty walking (gait disturbance) is especially common in myelopathy affecting the legs. Patients may describe unsteadiness, tripping, or needing support to walk 2, 7.

Autonomic Dysfunction

Bladder and bowel issues, such as urgency, incontinence, or retention, can occur when the spinal cord regions controlling these functions are affected. Early recognition is important, as these symptoms can point directly to spinal cord involvement 1, 3.

Types of Myelopathy

Myelopathy is not a single disease but a syndrome caused by various underlying pathologies. Understanding the types helps tailor diagnosis and treatment.

Type	Description	Common Features	Source(s)
Compressive	Due to physical pressure	Gradual onset, chronic	12, 13
Noncompressive	Not related to pressure	Acute/subacute onset	7, 11
Inflammatory	Immune-mediated/spinal cord inflammation	Rapid progression	3, 6
Vascular	Caused by blood flow issues	Sudden onset, stroke-like	9, 10
Hereditary/Metabolic	Genetic or nutritional	Slowly progressive	5, 8

Table 2: Major Types of Myelopathy

Compressive Myelopathy

This is the most common form, especially in older adults. It results from physical compression of the spinal cord due to degenerative spine disease, trauma, tumors, or herniated discs. Symptoms usually develop slowly and progressively 12, 13.

Noncompressive Myelopathy

Here, the spinal cord is affected by processes other than direct pressure. Causes include inflammation, vascular issues, infections, autoimmune disorders, metabolic deficiencies, and radiation. Onset can be acute, subacute, or chronic depending on the cause 7, 11.

Inflammatory Myelopathy

This type is rapid in onset and often related to autoimmune processes or infections (such as transverse myelitis). It can present with sudden weakness, sensory loss, and sometimes sphincter dysfunction 3, 6.

Vascular Myelopathy

Vascular causes include spinal cord infarction (stroke), arteriovenous malformations, or hemorrhage. The hallmark is a sudden onset of symptoms, often reaching maximum severity within hours 9, 10.

Hereditary and Metabolic Myelopathies

These forms are linked to genetic disorders or metabolic deficiencies (such as vitamin B12 deficiency). They tend to progress slowly and may be associated with other systemic symptoms 5, 8.

Causes of Myelopathy

The underlying causes of myelopathy are diverse, ranging from mechanical compression to immune attacks. Identifying the precise cause is crucial for proper treatment.

Cause	Example Conditions	Notable Features	Source(s)
Degenerative	Spondylosis, disc herniation	Gradual spinal cord compression	13, 17
Autoimmune	Multiple sclerosis, NMO	Inflammation, relapses	11, 6
Infectious	Viral, bacterial, fungal	Fever, rapid progression	4, 3
Vascular	Infarct, AVM, hemorrhage	Sudden onset, focal deficit	9, 10
Neoplastic	Tumors (primary/metastatic)	Local pain, progressive symptoms	2, 13
Metabolic	B12, E, copper deficiency	Slowly progressive, treatable	5, 11
Hereditary	Hereditary spastic paraplegia	Family history, slow progression	8, 5
Radiation/Paraneoplastic	Post-cancer therapy, antibodies	Subacute to chronic onset	11, 5

Table 3: Principal Causes of Myelopathy

Degenerative Causes

Degenerative changes, especially in the cervical spine, are the leading cause of myelopathy in adults. Spondylosis (wear-and-tear arthritis), ligament ossification, and herniated discs can all compress the spinal cord, leading to chronic symptoms 13, 17.

Autoimmune and Inflammatory Causes

Autoimmune conditions such as multiple sclerosis and neuromyelitis optica (NMO) can cause inflammatory attacks on the spinal cord. These are often characterized by episodes of rapid neurological decline, sometimes followed by partial recovery 11, 6.

Infectious Causes

Various pathogens can directly infect the spinal cord or trigger immune-mediated myelopathies:

• Viruses: Enteroviruses, herpesviruses, Zika virus
• Bacteria: Lyme disease (Borrelia), tuberculosis
• Fungi and parasites (rare) Patients may present with fever, back pain, and rapid progression of neurological symptoms, especially if immunocompromised 4, 3.

Vascular Causes

Myelopathy can result from disruption of blood flow, such as spinal cord infarction (stroke), arteriovenous malformations (AVMs), or hemorrhage. Onset is typically hyperacute, with symptoms peaking within hours 9, 10.

Neoplastic Causes

Tumors—either primary spinal cord tumors or metastases—can compress or infiltrate the cord. Tumor-related myelopathy often presents with local pain, progressive weakness, and sometimes early sensory symptoms 2, 13.

Metabolic and Hereditary Causes

Deficiencies in vitamin B12, E, or copper can cause metabolic myelopathy, which is potentially reversible with early treatment. Hereditary causes (like hereditary spastic paraplegia) often have a family history and slowly progressive symptoms 5, 8, 11.

Other Causes

Radiation-induced myelopathy and paraneoplastic syndromes (immune responses to cancer elsewhere in the body) are less common but important to consider, particularly in patients with cancer history 5, 11.

Treatment of Myelopathy

Treatment strategies for myelopathy are tailored to the underlying cause, severity, and progression of symptoms. Early intervention is often key to halting or reversing neurological decline.

Treatment Type	Indication	Key Considerations	Source(s)
Surgical	Compression (e.g. DCM)	Best for moderate/severe; prevents progression	14, 17, 16
Nonoperative	Mild compression, select metabolic	Rehab, physical therapy, monitor for worsening	15, 14
Immunotherapy	Inflammatory/autoimmune	Steroids, plasma exchange, disease-modifying drugs	6, 3
Antimicrobial	Infectious	Rapid initiation critical, add steroids if indicated	4, 3
Nutritional	Metabolic deficiencies	B12, E, copper replacement	5, 11

Table 4: Main Treatment Approaches

Surgical Treatment

Surgery is the mainstay for compressive myelopathy, particularly degenerative cervical myelopathy (DCM). Surgery aims to decompress the spinal cord and stabilize the spine, using approaches such as:

• Anterior cervical discectomy and fusion (ACDF)
• Laminectomy
• Laminoplasty Timely surgery can halt progression and often improves function, especially if performed early in the disease course 14, 16, 17.

Nonoperative Management

For mild cases of DCM and some metabolic or hereditary myelopathies, nonoperative management may be considered. This includes:

• Physical therapy and supervised rehabilitation
• Medications to manage symptoms
• Regular neurological monitoring for deterioration However, there is limited evidence that nonoperative treatment can halt disease progression, and patients must be closely observed for signs of worsening 15, 14.

Immunotherapy

Inflammatory and autoimmune myelopathies are treated with immunotherapies such as high-dose corticosteroids, plasma exchange, and disease-modifying agents (e.g., for multiple sclerosis). These treatments can reduce inflammation and, in some cases, prevent relapses 6, 3.

Antimicrobial Treatment

Infectious myelopathies require prompt treatment with appropriate antibiotics, antivirals, or antifungals. In some cases, adjunctive corticosteroids are added to reduce inflammation and improve outcomes 4, 3.

Nutritional and Supportive Therapy

For metabolic myelopathies, replacing deficient nutrients (like vitamin B12) is crucial. Supportive care is essential for all patients, including management of bladder and bowel dysfunction, pain control, and prevention of complications such as pressure ulcers and deep vein thrombosis 5, 11.

Conclusion

Myelopathy is a complex disorder with a wide spectrum of causes, symptoms, and treatments. Early recognition and accurate diagnosis are vital for effective management and to prevent permanent disability. Here’s a summary of key takeaways:

• Myelopathy presents with pain, motor and sensory deficits, gait disturbances, and autonomic dysfunction 1, 2, 3.
• Types include compressive, noncompressive, inflammatory, vascular, hereditary, and metabolic forms 12, 13, 7, 11, 5.
• Causes are broad—from degenerative spine disease to autoimmune, infectious, vascular, neoplastic, metabolic, hereditary, and radiation-related etiologies 13, 17, 11, 4, 5.
• Treatment depends on cause and severity: surgery for compression, immunotherapy for inflammation, antimicrobials for infection, and nutritional therapy for deficiencies 14, 17, 6, 4, 5.
• Timely intervention is crucial—delays can lead to irreversible neurological loss 16, 14.

By recognizing the varied presentations and understanding the underlying causes, healthcare providers and patients alike can work towards better outcomes in the management of myelopathy.