Cervical myelopathy is compression of the spinal cord in the neck — the most common cause of spinal cord dysfunction in adults over 55. Unlike radiculopathy (nerve root compression), myelopathy affects the cord itself, causing progressive difficulty with balance, hand coordination, and bladder function. It is a surgical condition — decompression is required to halt neurological deterioration and allow partial recovery.
What are the symptoms?
- Difficulty with fine motor tasks — handwriting, buttoning clothes, typing, or picking up small objects
- Gait instability or a broad-based 'spastic' walking pattern — feeling unsteady or frequently tripping
- Weakness in the arms or legs, sometimes affecting both sides
- Numbness or a 'glove-and-stocking' pattern of sensory loss in the hands and feet
- Urinary urgency or difficulty initiating urination (bowel/bladder dysfunction in more advanced cases)
- Electric shock sensation down the spine with neck flexion (Lhermitte's sign)
- Hyperreflexia — exaggerated reflexes in the legs — often detected on physical examination
What causes it?
- Cervical spondylosis: The most common cause — age-related disc degeneration, bone spur formation, and thickening of the spinal ligament (ligamentum flavum) that collectively narrow the spinal canal and compress the cord
- Cervical disc herniation: Large central disc herniations that encroach on the cord, more common in younger patients
- Ossification of the posterior longitudinal ligament (OPLL): A condition more prevalent in patients of Asian descent in which the ligament behind the vertebrae calcifies and narrows the canal
- Congenitally narrow spinal canal: Some patients have a narrower-than-average cervical canal from birth, making them more susceptible to cord compression with even mild spondylosis
How is it diagnosed?
MRI of the cervical spine is the primary diagnostic study — it shows the degree of cord compression and any signal change within the cord (T2 hyperintensity), which is a marker of cord injury and correlates with prognosis. CT scan provides complementary bone detail and is essential for surgical planning. Neurological examination documents the baseline deficit. Electrodiagnostic testing may be used to differentiate from peripheral neuropathy and other mimics.
Your Non-Surgical Roadmap — Surgery Is the Last Step
Most patients with this condition get better without surgery. Here's the path Dr. Chavarria follows before an operation is ever on the table:
- 1
Start conservative
Physical therapy, activity changes, anti-inflammatory or nerve medication, and time — the first line for nearly every spine condition.
- 2
Add targeted relief
If symptoms persist, image-guided injections (epidural or nerve blocks) can calm inflammation and pinpoint the source of pain — often avoiding surgery entirely.
- 3
Re-evaluate together
Dr. Chavarria reviews your progress and imaging with you, honestly, and explains exactly where you stand — no pressure, no rush to the OR.
- 4
Surgery — only if it's truly the best option
Reserved for severe or worsening nerve compression, instability, or when conservative care has had a fair chance. When it is right, you'll understand why and what to expect.
Treatment Options in Reno, NV — Conservative Care First
Cervical myelopathy does not reliably improve with conservative treatment — anti-inflammatory medications and physical therapy can provide modest symptom relief but do not address the underlying cord compression. Surgical decompression is the definitive treatment and is recommended before the condition becomes severe. Dr. Chavarria performs ACDF for one to three level disease, and posterior cervical laminectomy with or without fusion for multilevel compression or cases where the posterior approach is anatomically preferred. The timing of surgery matters: decompression before irreversible cord injury allows the best neurological recovery.
Treatment Procedures
ACDF (Anterior Cervical Discectomy & Fusion)
Anterior Cervical Discectomy and Fusion (ACDF) is one of the most commonly performed and consistently successful spine surgeries. Through a small incision in the front of the neck, the damaged cervical disc is removed, the nerve is decompressed, and the vertebrae are fused — eliminating the source of neck and arm pain.
Learn More →Posterior Cervical Fusion
Posterior cervical fusion approaches the cervical spine from the back of the neck to decompress the spinal cord and stabilize multiple vertebral levels with screws and rods. It is used for conditions where the anterior approach is not sufficient — including multilevel cervical stenosis with myelopathy, cervical instability, deformity, and cases where posterior bone anatomy needs to be directly addressed.
Learn More →Cervical Laminoplasty
Cervical laminoplasty is a motion-sparing procedure that relieves pressure on the spinal cord by reshaping and repositioning the vertebral bone (laminae) to expand the spinal canal — without fusing the vertebrae together. It is an excellent option for patients with multilevel cervical myelopathy who want to preserve neck motion and avoid a fusion.
Learn More →Cervical Disc Replacement (Arthroplasty)
Cervical disc replacement (cervical arthroplasty) removes a diseased cervical disc and replaces it with an FDA-approved artificial disc implant — preserving the natural motion of that spinal segment rather than fusing the vertebrae together. For the right candidate, this motion-preserving approach may reduce stress on adjacent levels over time.
Learn More →