What it is
Cervical myelopathy results from compression of the spinal cord itself — not just the nerve roots — within the cervical spine. The compression is most commonly caused by age-related degenerative changes: disc herniation, bone spur (osteophyte) formation, thickening of spinal ligaments, or a combination of all three narrowing the spinal canal.
Unlike cervical radiculopathy (which causes arm pain and is often self-limited), myelopathy affects the cord's long tracts and produces a different pattern of symptoms involving both the arms and legs.
Why it is different from radiculopathy
Myelopathy does not reliably improve on its own. The spinal cord, once significantly compressed and injured, has limited capacity for recovery. The natural history of moderate-to-severe myelopathy is gradual progressive neurological decline. This is one condition where the question is not whether to treat — but how quickly.
Surgical approach
The goal of surgery is decompression: creating space so the spinal cord is no longer under pressure. The approach depends on where the compression is greatest and how many levels are involved:
- Anterior approaches (ACDF, cervical disc arthroplasty, corpectomy) work well for one- or two-level disease, particularly when the compression is from the front
- Posterior approaches (laminoplasty, laminectomy with fusion) are preferred for multi-level disease or when the compression is predominantly posterior
Neurological improvement after surgery is possible, particularly when myelopathy is caught early. Preventing further decline is also a meaningful outcome. Delaying surgery in the setting of progressive myelopathy risks losing recovery potential.