Cervical Myelopathy: What It Is, How It Feels, and When Surgery Is Needed

When your neck starts to feel stiff and your hands won’t do what your brain tells them-like buttoning a shirt or holding a coffee cup without dropping it-you might think it’s just aging. But if you’re over 55 and these symptoms are getting worse, it could be something more serious: cervical myelopathy. This isn’t just a sore neck. It’s your spinal cord being squeezed in your cervical spine, and if left untreated, it can lead to permanent nerve damage, loss of balance, and even paralysis.

What Exactly Is Cervical Myelopathy?

Cervical myelopathy happens when the spinal cord in your neck gets compressed. The most common cause? Spinal stenosis-the narrowing of the bony canal that protects your spinal cord. Think of it like a garden hose getting pinched. Water still flows, but not as well. Over time, the pressure damages the nerves inside. This isn’t just wear and tear; it’s progressive neurological injury.

Most cases-about 75%-are called cervical spondylotic myelopathy (CSM). It’s tied to aging. As you get older, your discs dry out and flatten, losing up to 30% of their height between your 20s and 60s. Your facet joints swell from arthritis. The ligament behind your spine thickens. All of this pushes into the spinal canal. A healthy spinal canal is about 17-18mm wide. When it drops below 13mm, you’re in stenosis territory. At 10mm or less, you’re at serious risk for cord damage.

What makes this different from simple neck pain? Pain alone doesn’t mean myelopathy. You need neurological signs: weakness, numbness, loss of coordination. A 2023 study showed nearly 100% of people with confirmed myelopathy have these deficits. Pain is common-about half of patients feel it-but it’s the hand clumsiness and walking problems that signal real trouble.

What Do the Symptoms Actually Feel Like?

Symptoms don’t always start with pain. They sneak in. You might notice:

• Your fingers feel clumsy-dropping keys, struggling with zippers, or fumbling with your phone.
• Your legs feel heavy, like you’re walking through water.
• You trip more often, even on flat ground.
• You lose balance when turning your head or standing with your eyes closed.
• You start having trouble controlling your bladder-sudden urgency, or worse, accidents.

Doctors test for this with simple exams. Eighty-five percent of patients show exaggerated knee and ankle reflexes. Seventy-two percent report hand clumsiness. Sixty-eight percent have trouble walking steadily. These aren’t vague complaints-they’re measurable signs of spinal cord stress.

Progression isn’t the same for everyone. About 45% of people get worse slowly over two to five years. Thirty percent stabilize. But 25% decline fast-within six to twelve months. That’s why waiting is dangerous. Every month of delay can reduce your recovery potential by about 3%, according to experts at Northwestern University.

How Is It Diagnosed?

You can’t diagnose this with an X-ray alone. That might show bone spurs or disc space narrowing, but it won’t show if the cord is injured. The gold standard is an MRI. It picks up both the narrowing and changes inside the spinal cord itself-like swelling or scarring seen as bright spots on T2-weighted images.

Doctors use the Japanese Orthopaedic Association (JOA) score to measure severity. It’s a 17-point scale based on movement, sensation, and bladder control. A score below 14 means you have myelopathy. A score under 12 means you’re in the moderate-to-severe range-and surgery is strongly recommended.

Other tests help too. CT myelography gives a detailed view of bone and space. EMG and SSEPs detect nerve signal delays even before symptoms show up. About 60% of early-stage patients show abnormal nerve responses on these tests. If you’ve seen three doctors and still don’t have an MRI, you’re not getting the right care.

When Is Surgery Necessary?

Conservative treatment-physical therapy, NSAIDs, activity changes-might help a little. But only 28% of mild cases improve over two years. Sixty-three percent get worse. That’s not a gamble worth taking.

For moderate to severe myelopathy (JOA score below 12), surgery isn’t just an option-it’s the standard of care. The American Academy of Orthopaedic Surgeons gives this a Grade A recommendation based on Level I evidence. In one major study, 72% of surgical patients improved neurologically after two years. Only 29% of those who avoided surgery did.

Timing matters. Patients who have surgery within six months of symptoms start showing better recovery than those who wait over a year. Delaying by more than 12 months cuts your chance of a good outcome by 37%.

What Are the Surgery Options?

There are three main approaches, each with pros and cons:

Anterior Approach: ACDF and Disc Replacement

ACDF (anterior cervical discectomy and fusion) is the most common. The surgeon goes in from the front, removes the damaged disc and bone spurs, and fuses the vertebrae with a spacer and plate. It’s great for one or two levels. Satisfaction rates hit 90%. But there’s a catch: 5-7% of patients develop problems in adjacent discs within 10 years.

Now there’s a newer option: cervical disc arthroplasty. Instead of fusing, they replace the disc with an artificial one. The M6-C implant, FDA-approved in 2023 for two- to three-level cases, preserves motion. In trials, 81% of patients kept movement at two years-better than fusion’s 63%. It’s not for everyone, but it’s a big step forward.

Posterior Approach: Laminectomy and Laminoplasty

If the stenosis is spread across three or more levels, or if your neck is straight instead of curved, surgeons often go from the back. Laminectomy removes the back part of the vertebrae to open up space. Laminoplasty is like swinging a door open-you cut one side and hinge it open, then prop it with a bone wedge. It doesn’t require fusion, so you keep more neck motion.

Studies show laminoplasty has fewer post-op neck pains (15% vs. 32%) and works well for multilevel cases. But neurological recovery is slightly lower than with laminectomy plus fusion: 78% vs. 85%. Still, for many, the trade-off is worth it.

Combined Approaches

For complex cases-like severe deformity or prior failed surgery-doctors may combine front and back approaches. This is more invasive but sometimes necessary to fully decompress the cord.

What Happens After Surgery?

Recovery isn’t quick. Most people stay in the hospital 1-3 days. Full healing takes 3-6 months. You’ll need physical therapy for 8-12 weeks. Focus is on balance training, gait re-education, and strengthening your neck muscles.

Outcomes vary. Eighty-two percent of patients report better hand function after surgery. But only 65% regain normal walking ability. Nearly 30% still need a cane or walker. That’s not failure-it’s reality. The goal isn’t always to go back to how you were at 40. It’s to stop decline and preserve what you have.

Complications happen. About 4-6% face major issues: swallowing trouble (dysphagia), C5 nerve palsy (weak shoulder), or even worsening paralysis. Post-laminectomy syndrome-chronic neck pain after back surgery-affects 18%. But these risks are lower with experienced surgeons. Those doing more than 50 cervical procedures a year have 32% fewer complications.

What Can You Do Before Surgery?

If you’re waiting for surgery-or considering conservative care-there are things that help:

• Stop smoking. It cuts fusion success rates in half.
• Control blood sugar. Diabetics with HbA1c under 7.0 have infection risk drop from 8.5% to 3.2%.
• Stay active. Gentle walking and balance exercises keep your nerves firing. Avoid high-impact sports or heavy lifting.
• Get the MRI fast. Don’t wait. If you have neurological symptoms, get imaging within 2-4 weeks.

And don’t assume it’s just arthritis. If your hands are numb, your walk is off, or you’re having bladder issues, this isn’t normal aging. It’s a neurological emergency waiting to happen.

What’s New in Treatment?

The field is moving fast. Minimally invasive techniques like tubular laminoplasty cut blood loss by 65% and shorten hospital stays by almost two days. Robotic-assisted surgery is coming-expected to become standard by 2030, reducing revision rates from over 10% to under 7%.

Researchers are testing drugs like riluzole, used in ALS, to protect nerves during surgery. Early results show 12% better recovery on the JOA scale. Genetic markers, like COL9A2 mutations, might soon help predict who’ll decline fastest-so treatment can be personalized.

But there’s a warning. Surgeons are doing 33% more cervical procedures than in 2010. Yet patient selection hasn’t kept up. Experts estimate 15-20% of these surgeries might be unnecessary. That’s why diagnosis must be precise: symptoms + MRI findings + JOA score. Not just a bad neck and an X-ray.

Final Thoughts

Cervical myelopathy is silent until it’s not. It doesn’t hurt like a pulled muscle. It steals your coordination, your balance, your independence. And once the spinal cord is damaged, it doesn’t fully heal.

If you’re over 55 and your hands aren’t working right, your walk feels off, or you’re having bladder issues, don’t brush it off. See a spine specialist. Get an MRI. Know your JOA score. Understand your options.

Surgery isn’t a last resort-it’s the best chance to stop the damage. And the sooner you act, the better your outcome. Waiting doesn’t give you more time. It just gives the disease more time to win.