Myeloradiculopathy is a complex neurological condition where pathology simultaneously affects both the central and peripheral nervous systems within the spine. This diagnosis is made when two distinct issues, myelopathy and radiculopathy, occur together. It involves a disease process affecting the spinal cord (the central nervous system component) and the peripheral spinal nerve roots that branch off from it.
Defining the Affected Spinal Structures
The term myeloradiculopathy is a compound word describing the affected anatomy. The prefix “myelo-” refers to the spinal cord, the long, cylindrical structure running through the center of the vertebral column. This structure transmits motor and sensory signals between the brain and the rest of the body.
The “radiculo-” part refers to the nerve roots, which are the 31 pairs of peripheral nerves that exit the spinal column at each vertebral level. These roots carry specific signals to and from the limbs and torso. When compressed, nerve roots cause symptoms in a distinct, localized pattern known as a dermatome.
Myelopathy describes compression of the spinal cord itself, while radiculopathy is the irritation or compression of a single nerve root. Myeloradiculopathy signifies a severe, widespread compression that impacts both the spinal cord and the surrounding nerve roots. This dual involvement results in a complex clinical picture including signs from both the central and peripheral nervous systems.
Primary Causes of Compression and Inflammation
Myeloradiculopathy is primarily caused by conditions that narrow the space within the spinal canal, leading to mechanical compression and inflammation. Degenerative changes associated with aging are the most frequent culprits. Chronic wear and tear can lead to spinal stenosis (narrowing of the central spinal canal) and the formation of bone spurs (osteophytes) that impinge on the cord and roots.
Advanced spondylosis, or age-related degeneration of the discs and facet joints, causes the spine to lose height and stability. This process can result in a large, central disc herniation or bulging disc that presses directly on the spinal cord. Ligaments surrounding the spinal cord, such as the ligamentum flavum, can also thicken and harden, further reducing space for the neural tissue.
Traumatic injuries like severe whiplash or vertebral fractures can destabilize the spine and cause acute compression. Mass lesions, such as tumors, can also physically occupy space and exert pressure on both the cord and the nerve roots. Less commonly, infectious or inflammatory conditions, including abscesses or autoimmune disorders, can cause swelling and irritation leading to simultaneous dysfunction.
Clinical Signs and Symptom Presentation
The presentation is characterized by signs reflecting damage to both the spinal cord and the exiting nerve roots. Symptoms originating from spinal cord compression are myelopathic signs, which are often insidious and affect the body below the level of compression. Patients may experience a noticeable gait disturbance, such as stumbling or an uncoordinated walk.
Myelopathy often affects fine motor skills, leading to clumsiness in the hands and difficulty performing simple tasks like buttoning a shirt. Neurological examination reveals upper motor neuron signs, including hyperreflexia (exaggerated reflexes) and spasticity (muscle stiffness). A serious myelopathic sign is a change in autonomic function, such as urinary frequency, urgency, or incontinence, signaling significant cord compromise.
Symptoms arising from compressed nerve roots are radicular signs, which tend to be localized and sharp. These typically involve shooting or electrical pain that radiates down a limb into a specific area (a dermatome). This pain is accompanied by localized numbness, tingling, or sensory loss. Radicular signs also include lower motor neuron effects, such as muscle weakness and atrophy in the specific muscles supplied by that nerve root, often with diminished reflexes.
Managing and Treating the Condition
Management aims to relieve pressure on the spinal cord and nerve roots to prevent permanent neurological deficits and alleviate symptoms. Initial approaches involve conservative treatments, especially if symptoms are mild and stable. Non-surgical management includes nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and nerve-specific pain medications like gabapentin.
Physical therapy helps maintain strength, flexibility, and addresses posture-related issues. However, conservative care is often temporary due to the risk of ongoing spinal cord damage, requiring close monitoring of neurological status. If symptoms worsen or imaging shows significant spinal cord compression, surgical intervention is frequently necessary.
The goal of surgery is to decompress the neural structures by removing the source of pressure. Common procedures include laminectomy, corpectomy, or discectomy, which remove bone, disc material, or thickened ligaments. These decompression surgeries are often combined with spinal fusion to stabilize the vertebral column and prevent future irritation. Early surgical decompression is generally associated with better outcomes, particularly for patients with significant myelopathy.