Subtle symptoms shouldn’t be ignored

Pain in the neck or down an arm, or numbness in the fingers is enough to send many people over 50 to the doctor. It’s obvious something is wrong, especially if the pain has been going on for a while.

But sometimes, more subtle symptoms can signal a condition called cervical myelopathy, which occurs when a degenerative condition or arthritis of the small joints in the neck are narrowing the spinal canal and pressing on the spinal cord.

“Myelopathy can cause generalized weakness, poor balance, difficulty walking, difficulty with tasks that require precise use of the fingers,” says Dr. Mark Santman, an orthopaedic surgeon with Front Range Orthopaedics of Colorado Springs. “The patient just starts to feel clumsier. It’s so gradually progressive that often it gets chalked up to just getting older.”

Patients typically don’t associate some of these symptoms with a cervical spine problem.

“They’ll say they’re having trouble getting up out of a chair because their hips are weak, or they can’t hold a button to sew it onto a shirt, or they can’t use their key,” Dr. Santman says. “They may feel really unsteady when walking.”

Cervical myelopathy is the most common cause of spinal cord dysfunction in people over age 55. The risk increases as patients get older and develop arthritis.

In the absence of pain, cervical myelopathy can be hard for a family physician to diagnose, because there are many other reasons why an older person might be having difficulty with walking and balance. But when a pattern of symptoms develops like the ones Dr. Santman describes, the physician should consider sending the patient to a spine specialist or obtain a spine study such as an MRI scan.

Surgery can stop the condition from progressing and in some cases improve function, Dr. Santman says. The idea is to create more room for the spinal cord by removing the structure that’s pressing on the cord. The discs might be worn out in front, or might be pressing from the back because of thickened or buckled ligaments.

Patients usually are in the hospital for a day or two and may need to wear a cervical collar for four to six weeks for support and protection while they heal.

Not everyone who shows signs of cervical myelopathy on scans needs surgery.

“If a patient is not having symptoms, what we really need to do is follow the patient and make sure their level of functioning is not declining,” Dr. Santman says.

But about 30 percent of people who have early signs of myelopathy get significantly worse within two years and can be at increased risk of injury to the spinal cord from an accident or even a seemingly small injury.

While some people do get back some of the function they’ve lost, the primary goal of surgery is to keep patients from getting worse.

“Since surgical options are better for arresting progression than restoring function, we tend to intervene early once they start developing signs that the spinal cord isn’t happy,” Dr. Santman says.

Dr. Santman joined Front Range Orthopaedics in August 2010. While he maintains a special interest in complex cervical spine cases, he is well versed in the treatment of all areas of the spine for conditions ranging from arthritis and disc degeneration to trauma, tumors and infection. In addition to traditional surgical approaches, Dr. Santman is trained in cutting-edge technologies such as minimally invasive lateral access to the thoracic and lumbar spine.

He urges older patients or family members who notice the subtle symptoms of cervical myelopathy to bring them to the attention of their primary care provider.