My wife has a condition called cervical myelopathy from 30 years of bending over a sewing machine for her job. Now the surgeons are suggesting a procedure to take pressure off the spinal cord to help relieve the pain and other symptoms she has. She isn't really in favor of having surgery. The surgeons say she can't wait much longer without the possibility of permanent disability. How long can she put off the operation? Is there any way to tell when it's the best time to do this surgery?
Cervical myelopathy refers to any condition that causes degeneration, damage, or pathologic changes of the spinal cord in the cervical (neck) area. This condition can present with many different signs and symptoms. Difficulty walking has been mentioned. Limb spasticity (increased muscle tone) creates balance and walking problems. Other symptoms include neck and arm pain, electric shock sensation down the arms (called Lhermitte's sign), clumsiness of the hand(s), and difficulty with finger motion to name just a few.
Treatment for this problem can begin with nonoperative measures to improve posture and strengthen the neck muscles to help hold up the head. Stretching and relaxation techniques to help reduce muscle tightness or spasm may be needed. Sometimes a supportive collar is used at first for a short time to get symptoms under control. Surgery to decompress (take pressure off) the spine is advised when conservative care fails to change the clinical picture or when symptoms are no longer transient (come and go).
As to your question when is the best time to do surgery, the Japanese have come up with a new test for cervical myelopathy that can give doctors an idea of how severe the problem is and help predict when surgery might be helpful. The triangle step test (TST) is a motor performance test that reflects the condition of the pathways inside the spinal cord that control movement. It is called the triangle step test because of the way it's performed. No walking or upright balance is required. The patient sits in a chair and uses one foot to tap the three corners of a triangle (one corner after another). The number of steps or taps completed in 10 seconds is recorded. The test is repeated using the other foot.
Testing has shown that the TST can be used to predict when surgery might be helpful. They found that patients who could complete 20 or more steps in 10 seconds would benefit from surgery. Any less than that was predictive that surgery would not be beneficial. The TST is also a sensitive measure of change from before to after surgery and can be used to assess outcomes of treatment.
There's no easy answer for problems like this, no crystal ball to predict the future without surgery, or even the results of surgery should she have it done. Because of a concern for permanent paralysis when surgery is delayed, it is best to hear what the surgeons have to say and act accordingly.
Hisanori Mihara, MD, et al. A New Performance Test for Cervical Myelopathy. In Spine. January 2010. Vol. 35. No. 1. Pp. 32-35.
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