Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Back and neck conditions can sometimes be difficult to tell apart, as many share overlapping symptoms. Two commonly confused problems are myelopathy and radiculopathy—both involving the nerves, but in different ways. Myelopathy arises when the spinal cord itself is compressed, while radiculopathy occurs when the nerve roots branching out from the spine are affected. Read on to find out more about both conditions, what to look out for, and how they are diagnosed.
What Is Myelopathy?
Myelopathy is a condition caused by compression of the spinal cord, leading to nerve dysfunction that can interfere with movement, sensation, and coordination. Common symptoms include pain in the neck or back, tingling or numbness in the arms or legs, weakness, and difficulty with balance or walking. In more advanced cases, patients may also experience problems with hand dexterity or loss of bladder and bowel control.
Myelopathy may be categorised into different types:
- Cervical Myelopathy: The most common form, affecting the neck region
- Thoracic Myelopathy: Occurs in the mid-back region and is less frequent
- Lumbar Myelopathy: Found in the lower back, though much rarer compared to cervical or thoracic cases
Common Causes of Myelopathy
Myelopathy usually develops when the spinal cord is compressed, often as a result of age-related changes or other spinal conditions. Common causes include:
- Degenerative spinal conditions, such as spinal stenosis, which narrows the spinal canal
- Disc degeneration and herniation, pressing on the spinal cord
- Arthritis and bone spurs (osteophytes) that contribute to narrowing
- Autoimmune disorders, including rheumatoid arthritis, which can inflame spinal structures
- Trauma or spinal injury that damages the cord or surrounding tissues
- Spinal infections or inflammation that cause swelling and pressure
- Tumours, cysts or hematomas compressing the spinal cord
- Radiation therapy or certain neurological disorders that damage spinal tissues
Age-related wear and tear is one of the leading risk factors, making myelopathy particularly common in older adults.
Myelopathy Treatment
As myelopathy is caused by direct compression of the spinal cord, conservative treatment is rarely effective. Surgery is often required to relieve pressure and prevent further neurological decline. If left untreated, the condition can result in permanent nerve damage and serious disability. This makes early diagnosis and timely treatment essential to halt progression and protect long-term function.
What Is Radiculopathy?
Radiculopathy develops when a nerve root is compressed or irritated as it exits the spinal column, causing symptoms such as pain, numbness, tingling or weakness that radiate along the affected nerve pathway. It can occur in different regions of the spine and is classified based on its location:
- Cervical Radiculopathy (Neck Region): Often causes pain, weakness, or tingling in the shoulders, arms, and hands.
- Thoracic Radiculopathy (Mid-back Region): Less common, but may produce pain or discomfort in the chest and abdominal areas.
- Lumbar Radiculopathy (Lower Back Region): Frequently linked with sciatica, leading to pain, weakness, or numbness in the legs and feet.
Common Causes of Radiculopathy
Radiculopathy can develop when the nerve roots are compressed or irritated by various spinal conditions. The most frequent causes include:
- Herniated or Bulging Discs: Discs that protrude from their normal space can press on nearby nerve roots.
- Degenerative Changes (Arthritis or Spondylosis): Age-related wear and tear can damage spinal structures, narrowing spaces around nerves.
- Bone Spurs (Osteophytes): Extra bone growth can encroach on the nerve root’s exit pathway.
- Spinal Stenosis: Narrowing of the spinal canal or foramina reduces space for nerve roots, leading to compression.
- Trauma or Injury: Accidents or sudden impacts may damage spinal tissues and irritate nerve roots.
- Less Common Causes: Tumours, infections or inflammation can also affect the nerves and produce radiculopathy symptoms.
Radiculopathy Treatment
Radiculopathy is often temporary and may improve on its own, but persistent or severe cases require medical intervention. Most patients respond well to conservative measures such as medication, physiotherapy, and lifestyle adjustments, while epidural steroid injections can offer temporary relief. Surgery, such as microdiscectomy or foraminotomy, is usually reserved for cases that do not improve with other treatments. Unlike myelopathy, many cases of radiculopathy can be effectively managed without surgery.
How Do Doctors Differentiate the Two?
Doctors tell apart myelopathy and radiculopathy by carefully evaluating symptoms, conducting physical examinations and various diagnostic tests.
Medical History and Symptom Review
A review of symptoms often provides the first clue. Widespread balance and coordination difficulties may suggest myelopathy, while localised radiating pain, numbness or tingling is generally more typical of radiculopathy.
Physical Examination
Myelopathy commonly presents with hyperreflexia (overactive reflexes), weakness in multiple limbs and gait disturbances. Radiculopathy, on the other hand, usually causes decreased reflexes, muscle weakness and sensory loss limited to the distribution of the affected nerve root.
Imaging Tests
MRI is the most useful imaging tool, revealing spinal cord compression in myelopathy or nerve root impingement in radiculopathy. X-rays and CT scans may also be used to identify structural issues such as bone spurs, disc degeneration, or herniation.
Electrodiagnostic Tests
Nerve conduction studies and electromyography (EMG) can further clarify whether the problem lies in the spinal cord, as seen in myelopathy, or in the peripheral nerve roots, as in radiculopathy.
Although myelopathy and radiculopathy both involve nerve-related conditions, the difference lies in whether the spinal cord or the nerve roots are affected. Myelopathy is usually more serious and requires early surgical intervention, while radiculopathy can often be managed conservatively unless symptoms persist or worsen.
If you are experiencing unexplained neck pain, limb weakness, or nerve-related symptoms, please do not hesitate to seek medical evaluation from a spine specialist to ensure timely diagnosis and appropriate care.
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.
