Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
The spinal cord serves as the body’s main communication pathway between the brain and the rest of the body. When it becomes compressed, myelopathy can occur. It is a serious and often progressive condition requiring prompt diagnosis and care. Myelopathy can develop anywhere along the spine, with symptoms and treatment depending on its location.
The two most common types are cervical myelopathy (in the neck) and thoracic myelopathy (in the mid-back). Understanding their differences is key to early intervention and better outcomes.
What Is Cervical Myelopathy?
Common Causes
Most cases develop gradually due to degenerative changes in the spine, known as cervical spondylotic myelopathy (CSM). Contributing factors include:- Degenerative Disc Disease: Disc dehydration and height loss cause bulging or herniation into the spinal canal.
- Osteoarthritis/Spinal Stenosis: Bone spurs and thickened ligaments narrow the canal, compressing the cord.
- Congenital Narrowing: A naturally smaller spinal canal increases susceptibility to compression.
- Trauma: Fractures or injuries to the neck can cause acute cord compression.
Typical Symptoms
Early signs may be subtle, making diagnosis challenging. Symptoms often progress to include:- Gait Disturbances: Unsteady walking or a “walking on air” sensation
- Loss of Fine Motor Skills: Hand clumsiness or difficulty with tasks like writing or buttoning clothes
- Sensory Changes: Numbness, tingling or electric shock sensations radiating down the limbs
- Motor Weakness: Weakness in the arms and legs
- Bowel or Bladder Dysfunction: In advanced cases, loss of control may occur
What Is Thoracic Myelopathy?
Common Causes
Thoracic myelopathy often arises from structural or vascular issues rather than typical age-related degeneration. Common causes include:- Ossification of the Posterior Longitudinal Ligament (OPLL): This occurs when the ligament along the back of the spinal canal thickens and hardens, gradually narrowing the space and compressing the spinal cord.
- Thoracic Disc Herniation: Although rare in this region, a herniated disc can press directly on the spinal cord and cause significant neurological symptoms.
- Spinal Tumours: Both benign and malignant growths may develop within or near the spinal canal, exerting pressure on the spinal cord.
- Arteriovenous Malformations (AVMs): These are abnormal tangles of blood vessels that can compress the cord or interfere with its blood supply, leading to progressive neurological decline.
Typical Symptoms
Symptoms usually occur below the level of compression, affecting the trunk and lower limbs:- Leg Weakness and Spasticity: Tightness, stiffness or reduced leg strength
- Truncal Sensory Loss: Numbness or tingling around the chest or abdomen
- Gait Ataxia: Difficulty maintaining balance and coordinating leg movements
- Bladder and Bowel Changes: Often appear earlier and more severely than in cervical myelopathy due to affected nerve pathways in this region
Key Differences Between Cervical and Thoracic Myelopathy
While both conditions involve spinal cord compression, their location determines the pattern and severity of symptoms.
Location of Symptoms
In cervical myelopathy, compression in the neck affects all four limbs, causing hand clumsiness, balance issues and leg weakness. In thoracic myelopathy, only the trunk and legs are involved, while arm function remains unaffected.
Severity and Progression
Cervical myelopathy usually develops slowly over months or years due to chronic degeneration. On the other hand, as thoracic myelopathy is often linked to tumours or vascular causes, it may appear suddenly and progress rapidly.
Impact on Daily Activities
Cervical compression impairs fine motor control, making tasks like buttoning clothes or writing difficult. Thoracic compression primarily affects mobility, leading to leg stiffness, weakness and increased reliance on walking aids.
Cervical compression impairs fine motor control, making tasks like buttoning clothes or writing difficult. Thoracic compression primarily affects mobility, leading to leg stiffness, weakness and increased reliance on walking aids.
Importance of Early Diagnosis and Treatment
Myelopathy requires prompt recognition and treatment, as delayed intervention can lead to permanent neurological damage. The longer the spinal cord remains compressed, the lower the chances of full recovery, even after successful surgery.
Accurate diagnosis begins with a comprehensive neurological examination to assess reflexes, strength and sensation, followed by key imaging tests:
- MRI: The gold standard for visualising the spinal cord, discs and ligaments, as well as detecting swelling or early damage.
- CT Scan: Useful for evaluating bone spurs, spinal alignment and other structural changes.
Early diagnosis enables timely treatment, helping prevent irreversible complications such as mobility loss or bladder dysfunction. If you experience symptoms of myelopathy, consult our neurosurgeon in Singapore for an accurate diagnosis and to determine the most effective course of treatment. Contact us today to schedule an appointment.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a Senior Consultant Neurosurgeon and the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Column held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
