Myelopathy can be defined as any disorder in which the tissue of the spinal cord is diseased or damaged.


Anything that interrupts the normal flow of neural impulses through the spinal cord may cause a clinical myelopathy. Some of the causes are trauma, viral processes, inflammatory or autoimmune disorders, tumor, or degenerative processes including spondylosis and intervertebral disc herniation.


Symptoms may include: numbness of the hands, clumsiness of the hands, arm weakness, hand weakness, leg stiffness (“walking like a robot”), loss of balance, and urinary urgency. Neck pain may also be present but is usually not a significant complaint.


Diagnosis is usually made based on the patient’s history and examination and radiographic studies that confirm critical cervical stenosis with compression of the spinal cord. Post-myelography computed tomography (myelo-CT) or magnetic resonance imaging (MRI) may be used to obtain high-resolution images of the cervical spinal canal and the spinal cord.



Non-surgical treatment generally consists of a combination of temporary immobilization of the neck, steroidal and/or non-steroidal anti-inflammatory medications (such as COX-2 inhibitors or ibuprofen), as well as physical therapy.

Depending on the specific MRI/CT myelogram findings, other potential treatment options include various forms of cervical traction and epidural steroid injections.


Surgical procedures to decompress the spinal cord include approaches from the front of the neck (anterior cervical discectomy and fusion, anterior cervical corpectomy), from the back of the neck (cervical laminectomy, cervical laminectomy and fusion, cervical laminoplasty) and combined procedures in which both an anterior and a posterior approach are used. The exact procedure performed is based partly on the location of the stenosis and the overall alignment of the cervical spine, but many factors are considered in the decision.


Cervical Fusion

General Considerations:

  • Decrease swelling
  • Prevent stiffness
  • Increase activity tolerance
  • Improve stabilization


  • With Anterior Cervical Fusion – avoid extension
  • With Posterior Cervical Fusion – avoid flexion
  • Range of motion is patient dependent and based on physician preference and the level and number of fusions.

Lumbar Fusion Protocol

General Considerations:

  • Decrease swelling / inflammation
  • Prevent stiffness / soft tissue mobilization as needed
  • Increase activity tolerance
  • Begin stabilization / restrict lumbar ROM
  • Pain / symptom modulation as needed


  • Avoid range of motion at fusion level
  • Allowance of range of motion is physician-dependent
  • Avoid excessive loading and distraction
  • Avoid rotational activities until cleared by physician (minimum of 4 months)