Cervical Myelopathy: Spinal Stenosis Symptoms and When Surgery Is Needed
When your hands start fumbling with buttons, your walk feels unsteady, or you suddenly drop things you used to handle without thinking, it’s easy to blame aging. But if these symptoms are new, worsening, and paired with numbness in your arms or trouble controlling your bladder, it could be something more serious: cervical myelopathy. This isn’t just a stiff neck. It’s your spinal cord being squeezed in your neck - and if left untreated, it can lead to permanent nerve damage.
What Exactly Is Cervical Myelopathy?
Cervical myelopathy isn’t the same as cervical stenosis, though the two are often confused. Spinal stenosis means the space inside your neck bones has narrowed. Cervical myelopathy means that narrowing is actually squishing your spinal cord - and damaging it. Think of it like this: stenosis is the pipe getting smaller. Myelopathy is the water inside the pipe starting to leak because the walls are crushed. The most common cause is cervical spondylotic myelopathy (CSM), which happens as part of normal aging. Over time, discs between your neck bones dry out and collapse, bone spurs grow, ligaments thicken, and joints swell. All of this slowly eats away at the space meant for your spinal cord. By age 70, nearly 1 in 11 people have signs of it. It’s the top reason adults over 55 develop spinal cord problems that aren’t from injury.How Do You Know It’s Not Just Arthritis?
Many people assume neck pain and stiffness mean arthritis. But myelopathy doesn’t always hurt. In fact, up to half of patients don’t even have neck pain. The real red flags are neurological - changes in how your body moves and feels. Early signs include:- Clumsy hands - fumbling with keys, dropping utensils, struggling to tie shoelaces
- Walking like you’re drunk - unsteady gait, bumping into things, feeling like your feet are heavy
- Numbness or tingling in fingers, arms, or legs
- Weakness in arms or legs - difficulty lifting objects or climbing stairs
- Increased reflexes - your doctor might notice your knee or ankle jerks too hard during an exam
How Is It Diagnosed?
A doctor can’t just look at an X-ray and say, “You’ve got myelopathy.” That’s because many people over 40 have narrow spinal canals without any symptoms. The key is finding both the narrowing and signs of spinal cord injury. The gold standard is an MRI. It shows exactly where the cord is being squished and whether there’s damage inside the cord itself - seen as bright spots on T2-weighted images. A normal spinal canal is about 17-18mm wide. At 13mm or less, it’s stenotic. At 10mm or under, it’s severe - and myelopathy is likely. Doctors also use the Japanese Orthopaedic Association (JOA) score. It’s a simple test that checks motor function, sensation, and bladder control on a scale of 0 to 17. A score below 14 means myelopathy is present. X-rays help spot bone spurs and disc collapse, but they don’t show the cord. EMG and nerve tests can catch early damage even before symptoms get bad.When Is Surgery the Only Real Option?
Conservative treatment - physical therapy, pain meds, activity changes - might help a little if your symptoms are mild. But here’s the hard truth: only about 28% of people with mild myelopathy improve over two years. Almost two-thirds get worse. If your JOA score is below 12, or if your symptoms are getting worse - even slowly - surgery is the only proven way to stop the damage. The American Academy of Orthopaedic Surgeons gives this a strong, top-level recommendation. Delaying surgery doesn’t just mean more pain. It means less chance of recovery. Studies show that patients who have surgery within six months of noticing symptoms recover 37% better than those who wait over a year. Every month you wait, your chance of full recovery drops by about 3%.
What Surgery Options Exist?
There’s no one-size-fits-all fix. The right approach depends on where the cord is compressed, how many levels are involved, and your spine’s natural curve. Anterior approaches (from the front of the neck):- ACDF (Anterior Cervical Discectomy and Fusion): Removes the damaged disc and fuses the bones with a plate. Best for 1-2 level problems. Success rate: 85-90% for symptom relief. Downside: 5-7% risk of needing another surgery nearby in 10 years.
- Cervical Disc Arthroplasty (Artificial Disc): Removes the disc but replaces it with a moving implant. Preserves motion. FDA approved for 2-3 levels in 2023. Early results show 81% success at two years - better than fusion for keeping movement.
- Laminectomy with fusion: Removes the back part of the bone to relieve pressure, then fuses the spine. Used for multi-level disease. High success (85%) but can cause more post-op neck pain.
- Laminoplasty: Hinges the bone open like a door instead of removing it. Less pain, faster recovery. Works best for 3+ levels. Slightly lower neurological recovery (78%) than fusion, but fewer complications.
What Are the Risks?
Surgery isn’t risk-free. About 4-6% of patients face major complications:- Dysphagia (trouble swallowing) - affects 22% in the first few months, usually fades
- C5 nerve palsy - shoulder or arm weakness, happens in 3-5% of cases
- Neurological worsening - rare, but 1-2% of patients end up worse after surgery
- Chronic neck pain - 18-35% of patients still have discomfort months later
What Happens After Surgery?
Recovery isn’t quick. Most people stay in the hospital 1-3 days. Full healing takes 3-6 months. You’ll need physical therapy for 8-12 weeks. Focus is on regaining balance, retraining your hands, and strengthening your neck muscles. About 82% of patients report better hand function a year after surgery. But only 65% regain normal walking ability. Some will still need a cane or walker. The earlier you operate, the better your odds of full recovery.
What Should You Do If You Suspect It?
If you’ve noticed any of these symptoms - especially if they’re getting worse - don’t wait. See a spine specialist. Don’t rely on your primary care doctor to diagnose this. It’s easy to miss. The average patient sees three doctors before getting the right diagnosis - and waits nearly 15 months. Get an MRI within 2-4 weeks of noticing neurological symptoms. Don’t delay. If your doctor says, “Just wait and see,” get a second opinion. The data is clear: early surgery saves function. Late surgery saves you from worse outcomes - but not from permanent damage.What’s Changing in Treatment?
The field is moving fast. New tools are helping doctors pick the right surgery for the right person:- Robotic-assisted surgery is being tested - it could cut revision rates by a third by improving precision
- Genetic tests are being studied to predict who degenerates faster
- Drugs like riluzole are being tested alongside surgery to protect nerves during recovery
It’s not about avoiding surgery. It’s about doing it at the right time - before your hands stop working, before your walk becomes unsafe, before you lose control of your body. Cervical myelopathy doesn’t fix itself. And waiting too long means losing the chance to get it back.
Can cervical myelopathy get better without surgery?
In rare cases, mild symptoms may stabilize with rest and physical therapy, but true improvement without surgery is uncommon - only about 28% of patients see any benefit over two years. Most people (63%) get worse over time. If your symptoms are worsening, even slowly, surgery is the only way to prevent permanent damage.
How do I know if I need surgery?
If your JOA score is below 12, or if you’re experiencing worsening hand clumsiness, gait problems, or bladder control issues, surgery is strongly recommended. Imaging must show spinal cord compression with signs of damage (like T2 hyperintensity on MRI). If your symptoms are getting worse, don’t wait - early intervention gives you the best chance of recovery.
What’s the difference between ACDF and laminoplasty?
ACDF is done from the front of the neck and is best for 1-2 levels. It fuses the bones, which stops motion at that spot but gives strong relief. Laminoplasty is done from the back, opens up the spinal canal like a door, and is better for 3 or more levels. It preserves neck movement and causes less pain, but neurological recovery is slightly lower than with fusion.
How long does recovery take after cervical myelopathy surgery?
Most patients go home in 1-3 days. You’ll need physical therapy for 8-12 weeks. Full recovery - including regaining hand function and stable walking - typically takes 3 to 6 months. Some people continue improving for up to a year. The sooner you start rehab, the better your outcome.
Can I avoid surgery with exercise or chiropractic care?
Exercise and physical therapy can help maintain strength and mobility, but they won’t reverse spinal cord compression. Chiropractic adjustments in the neck are not recommended and can be dangerous if you have myelopathy. The spinal cord is already compressed - adding force to it risks further injury. Surgery is the only proven way to relieve pressure on the cord.
What happens if I ignore the symptoms?
Ignoring symptoms leads to progressive nerve damage. Between 20% and 60% of untreated patients will experience significant worsening over 2-5 years. This can mean permanent weakness, loss of coordination, paralysis, or loss of bladder/bowel control. Once the spinal cord is severely damaged, even surgery can’t restore lost function.
What’s the Bottom Line?
Cervical myelopathy isn’t something you can out-wait. It doesn’t heal on its own. The symptoms start small - a dropped spoon, a stumble on the stairs - but they don’t stop there. If you’re noticing changes in how your body moves, don’t brush them off. See a specialist. Get an MRI. Know your options. Surgery isn’t a last resort - it’s the best chance to keep your body working as it should. And timing matters more than you think.You might like
