Cervical Myelopathy - Local Cause, Distant Effects

Posted in Head Pain Disorders on Jun 27, 2022

“Cervical myelopathy” is probably not a term that you’ve heard of before UNLESS you’ve recently had some type of CT scan or MRI where the report diagnosed you with having it.

Cervical refers to your neck. Myelopathy is a broad term that refers to the dysfunction of nerves. Specifically, as it relates to cervical myelopathy, there are many symptoms associated:

  • Headaches and migraines
  • Neck and should pain
  • Hand pain or tingling similar to a carpal tunnel syndrome (but isn’t carpal tunnel syndrome)
  • Hand and arm weakness
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Cervical myelopathy can also be related to other neuralgia types of issues such as suboccipital neuralgia, trigeminal neuralgia, and, as we’re going to mention in this article, fibromyalgia, dizziness, vertigo, and chronic fatigue. 

My specialist doesn’t think my disc is what’s causing my cervical myelopathy symptoms

Cervical myelopathy is commonly diagnosed when a disc bulge is discovered in the lower part of the neck (most commonly at C5-C6, and second most commonly at C4-C5). In brief, cervical discs do not just spontaneously bulge unless you’ve experienced a really wicked injury like getting hit by a truck. Instead, they erode over a long period of time until they reach critical mass to the point where they infiltrate into the area inside your vertebrae where your nerves and spinal cord exit.

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It’s at this point when many people get CT and MRI scans performed that they discover the problem. Depending on the extent of it, many people work with a chiropractor and physiotherapist to improve their condition, which often helps. Other times if the damage is so severe, surgery is the only option.

At the same time, many people are told that they do have a bulging disc in their lower neck, but that their specialist doesn’t think that’s what actually causes the problem. It’s for these people specifically that I want to speak now to share with you some really important information about how cervical myelopathy actually happens that may explain what is actually going on.

How your upper neck is related to cervical myelopathy

Cervical myelopathy isn’t just a local thing. That is, just because you see a disc bulge at a certain level does NOT mean that is where the problem is limited. In fact, a local site of pressure, narrowing (aka stenosis) often causes your spinal cord to stretch up to 30mm above and below the site of stenosis, which often correlates with 3 vertebral segments above and below the actual area.

This is actually one of the reasons why it can sometimes be difficult to get an exact diagnosis on the type of cervical nerve pro blew you may have because when you affect your spinal cord, the results are often mixed. As a result, any treatment you have in the area of your shoulder, brachial or nerve plexus in that area, or even your elbow or hand may have limited results.The good news is that your spine is flexible and able to absorb much of the stretch upwards of around 10mm. In other words, you don’t instantaneously develop symptoms. Again, this is one reason why so many people may only recently experience cervical myelopathy symptoms even though their problems have been developing for 30 years.

Here’s the key to all this: that 10mm worth of stretch is only applicable to your lower neck. In your upper neck at the level of the C1 (atlas) and C2 (axis) vertebrae), the total amount of stretch that your spinal cord can tolerate is only 3mm. The reason for the difference is that your atlas and axis are tethers onto the connective tissue that protects your brainstem via a series of tension cables known as myodural ligaments (or myodural bridges). You see, the C1 and C2 do not have a disc between them. Thus, these ligaments work to normally hold the vertebrae (and spinal cord) in position), hence the extra tension. 

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However, if or when this vertebra should ever misalign significantly from its normal position, instead of protecting your spinal cord, it may exert direct tension that in turn stretches it. And, what did we say about stretch? It isn’t limited to the site of the obstruction. Instead, it transmits the stretch up and down, which in the case of the atlas and axis vertebra means that the areas in the firing line include your lower spinal cord, and also your brainstem, which is the master control centre for all the neural communication that goes on in your body, including the sensory processing centres for your upper and lower limbs.

It is also unfortunate that this area of the spine, as important as it is, is often the most overlooked area. And this may well explain why it is that so many people who experience symptoms of cervical myelopathy are told that their findings are relatively normal. Or that their disc bulges probably aren’t big enough to be causing their symptoms. Or that even if they do different activities like chiropractic, physiotherapy, or massage for the lower neck area they don’t notice any difference. It could well be that the missing part is actually ever so slightly higher at the base of your skull! 

Atlas Treatment and Cervical Myelopathy

If you are looking for a different approach to helping cervical myelopathy before drugs or surgery as a last resort, upper cervical care may be an option for you. Upper cervical care refers to a specific treatment protocol that focuses on the alignment of those top vertebrae in your neck: the atlas (C1) and axis (C2). 

Upper cervical is a special division of general chiropractic that was researched and developed in the USA (unfortunately with very few practitioners here in Australia). Atlas Health is the leading upper cervical health centres located in North Lakes (north Brisbane) for people from across Queensland and even interstate. We are familiar with a variety of upper cervical methods (including the Atlas Orthogonal and NUCCA techniques). 

Our specific focus is on the Blair technique, which recognises that every human being is different on the outside and also the inside, Therefore, in order to identify exactly what is going on in your unique case, it is necessary to perform a sieges of premises physical, neurological and diagnostic images that take these differences into account. Then, with this information, it is possible to tailor an individualised case recommendation that addresses the exact location, directions, and degree of any vertebral misalignment in your neck that could be producing cord stretch and linked to cervical myelopathy symptoms. Unlike general spinal manipulation, there is no twisting, stretching, or cracking with the Blair technique. The procedure is designed to be as light and precise as possible, but also so that it can deliver the best chance of positive success.

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If you would like more information, we offer a 15-minute complementary over-the-phone consultation to discuss your individual needs and to answer any questions you may have so that you can decide if upper cervical care is right for you. Click the contact us link at the top of this page or call us direct at 07 3188 9329.

References

Dennis AK, Oakley PA, Weiner MT, et al. Alleviation of neck pain by the non-surgical rehabilitation of a pathologic cervical kyphosis to a normal lordosis: a CBP® case report. J Phys Ther Sci. 2018 Apr;30(4):654-657. doi: 10.1589/jpts.30.654. Epub 2018 Apr 20. https://www.ncbi.nlm.nih.gov/pubmed/29706725

Fortner MO, Oakley PA, Harrison DE. Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP® case report. J Phys Ther Sci. 2018 Feb;30(2):266-270. doi: 10.1589/jpts.30.266. Epub 2018 Feb 20.

Kessinger RC, Boneva DV. Case Study: Acceleration/Deceleration Injury with Angular Kyphosis. J Manipulative Physiol Ther, 2000; 23(4):279-87.

McAlpine JE. Subluxation Induced Cervical Myelopathy: A Pilot Study. Chiropr Res J, 1991; 2(1):7-22.

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Moustafa IM, Diab AAM, Hegazy FA, Harrison DE. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects? J Back Musculoskelet Rehabil. 2017;30(4):937-941. doi: 10.3233/BMR-150464.

Murphy DR, Hurwitz EL, Gregory AA. Manipulation in the presence of cervical cord compression: a case series. J Manipulative Physiol Ther. 2006 Mar-Apr;29(3):236-44. https://www.ncbi.nlm.nih.gov/pubmed/16584950

Vallejo R, Kramer J, Benyamin R. Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature. Pain Physician. 2007 Mar;10(2):305-11. https://www.ncbi.nlm.nih.gov/pubmed/17387353

Wickstrom BM, Oakley PA, Harrison DE. Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci. 2017 Aug;29(8):1472-1474. doi: 10.1589/jpts.29.1472. Epub 2017 Aug 10.

Sharpless SK. Susceptibility of spinal roots to compression block. The Research Status of Spinal Manipulative Therapy. NINCDS monograph 15, DHEW publication (NIH) 76-998:155, 1975.

Reid JD. Effects of flexion-extension movements of the head and spine upon the spinal cord and nerve roots. J Neurol Neurosurg Psychiatry. 1960 Aug;23(3):214-21. doi: 10.1136/jnnp.23.3.214. PMID: 13740493; PMCID: PMC497411.

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Wolf K, Reisert M, Beltrán SF, Klingler JH, Hubbe U, Krafft AJ, Egger K, Hohenhaus M. Focal cervical spinal stenosis causes mechanical strain on the entire cervical spinal cord tissue - A prospective controlled, matched-pair analysis based on phase-contrast MRI. Neuroimage Clin. 2021 Feb 1;30:102580. doi: 10.1016/j.nicl.2021.102580. Epub ahead of print. PMID: 33578322. https://pubmed.ncbi.nlm.nih.gov/33578322/

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