Cervical Myelopathy: What Is It and How Do You Know You Have It?
Cervical myelopathy is a condition in which the spinal cord in your neck gets pressed, usually by wear-and-tear changes in the bones or discs. It can cause clumsy hands, trouble walking and changes in feeling. It tends to get worse over time, so spotting it early matters.
Key points
- Cervical myelopathy is caused by pressure on the spinal cord itself, not just on a single nerve.
- Early signs are often subtle, such as clumsy hands, stiff legs or poor balance.
- It is different from radiculopathy, which affects a nerve root and usually causes pain down one arm.
- A standing, weight-bearing scan can show how spinal alignment changes under gravity. Scans done lying down may not show this.
- If you notice sudden weakness, loss of bladder or bowel control, or symptoms that get worse quickly, get urgent medical help.
Your spinal cord is the main nerve highway. It runs from your brain down through the bones in your neck. When those bones, discs or ligaments narrow the space around the cord, the cord gets squeezed. That squeezing is called cervical myelopathy. The spinal cord carries signals to your whole body, so the effects can be surprisingly wide.
The most common form is cervical spondylotic myelopathy, sometimes called degenerative cervical myelopathy. It develops slowly as the spine ages. Bone spurs grow, discs bulge, ligaments thicken, and the canal that protects the cord slowly shrinks. Many people do not realise anything is wrong until daily tasks become clearly harder.
What are the early signs of cervical myelopathy?
The earliest signs are often small changes in hand control and balance. You might struggle with buttons, drop things more often, or feel unsteady on your feet, especially in the dark. These signs are easy to ignore, but they are worth paying attention to.
Some people also feel an electric-shock sensation running down the spine when they bend the head forward. This is called Lhermitte's sign. It is a recognised symptom of pressure on the spinal cord in the neck. Pain is not always the main feature. Many people have more trouble with everyday function, such as grip or walking, than with actual pain.
What causes cervical myelopathy?
The most common cause is age-related wear and tear in the cervical spine. Over time, several changes can narrow the spinal canal and press on the cord.
Some people are born with a naturally narrower spinal canal. They may have no symptoms for decades. Then the extra wear-and-tear changes of ageing tip things over the edge. Poor posture and alignment can also play a part. When the cervical spine loses its natural curve, extra load falls on certain segments. This speeds up the wear.
When should you get urgent help for cervical myelopathy symptoms?
Get urgent medical help if you develop any of the following. These may be signs of spinal cord pressure that is getting worse quickly and needs to be checked promptly.
Get urgent help (your doctor or the nearest emergency department) if you notice:
- Sudden weakness in your arms or legs, or weakness that gets worse quickly
- Loss of bladder or bowel control
- Numbness that spreads quickly or affects both sides of your body
- Trouble walking that comes on suddenly rather than slowly
These warning signs do not always mean the worst, but they need a prompt medical review. Do not wait for a routine appointment or a scan.
What is the difference between cervical myelopathy and radiculopathy?
Cervical myelopathy affects the spinal cord itself, while cervical radiculopathy affects a single nerve root branching off the cord. The two can happen together, but the pattern of symptoms is different.
- Both hands affected
- Balance and walking problems
- Clumsiness rather than sharp pain
- Symptoms in arms and legs
- Usually one arm affected
- Sharp, shooting pain down the arm
- A specific area of numbness or weakness
- Legs usually not affected
Both conditions involve the cervical spine. Sometimes a scan shows pressure at more than one level. Knowing which structure is affected helps decide what kind of specialist you may need to see. You can read more about how the spine works as a connected chain on our spine page.
How does a standing scan help assess cervical myelopathy?
A standing, weight-bearing scan shows how your spine behaves under gravity, the way it works in real life. When you lie down for a usual scan, gravity is taken away and the muscles relax. The spine can then settle into a position that hides alignment problems.
Your body is a connected chain from your feet to your head. If your lower back has lost its curve, or your pelvis is tilted, your neck may make up for it by shifting forward to keep your head balanced. That forward shift narrows the spinal canal further. A scan done lying down would not show this extra narrowing, because the posture your body uses to make up for it disappears when you lie flat.
An EOS scan takes a full standing image from head to toe in one pass, using about 90% less radiation than a standard X-ray, around ten times less. It lets a specialist see the whole alignment picture, not just the neck on its own. The result is a clearer view of how much the canal may be narrowing when you are upright.
Not sure whether a standing alignment scan would add useful information about your cervical spine? A free video consultation can help you decide before you plan a trip to London.
Book a free video consultationA note about MRI. EOS shows bones, joints and alignment very well. For soft-tissue detail, such as the spinal cord itself, the discs or the nerves, MRI is usually the better tool. Many people benefit from both types of scan. Your treating specialist can advise which combination makes sense for you.
What are the treatment options for cervical myelopathy?
Treatment depends on how severe the pressure is and how quickly symptoms are getting worse. A specialist, usually a spine surgeon or neurologist, will decide the best approach based on a clinical examination and scans.
In mild or very early cases, monitoring and physiotherapy may be recommended to keep up movement and strength. When the pressure on the cord is more significant or symptoms are getting worse, surgery to decompress the spinal canal is often considered. The aim of surgery is to stop further decline and, where possible, allow some recovery.
Accurate imaging plays a key role in these decisions. Understanding the full alignment of the spine, not just the affected vertebrae, helps the surgical team plan the best approach. For details on what an EOS alignment assessment includes, visit our overview page.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help you.
Common questions about cervical myelopathy
It is a condition where the spinal cord in your neck gets squeezed, usually by age-related changes in the bones, discs or ligaments. This pressure interferes with the signals travelling between your brain and the rest of your body.
It is the most common type of cervical myelopathy. "Spondylotic" means it is caused by spondylosis, the normal wear and tear that happens in the spine as you get older. Bone spurs, bulging discs and thickened ligaments all play a part.
Cervical myelopathy tends to be a progressive condition. This means it usually stays the same or gets worse over time, rather than improving by itself. That is why spotting it early and getting a specialist review are important.
A trapped nerve (radiculopathy) affects one nerve root and usually causes pain or weakness in one arm. Myelopathy presses on the spinal cord itself, so it can affect both arms, both legs, balance and coordination.
No. ScanAlign is a private, self-pay clinic, and you can book directly without a referral from your doctor or a consultant. You start with a free video consultation to discuss whether a standing alignment scan is right for you.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. You can read more about safety and what to expect on our FAQs page.
An EOS scan takes a full standing image from head to toe in one pass, so a specialist can see how your whole skeleton lines up under gravity. A standard X-ray usually shows just one area, and often with you lying down.
Poor posture alone does not cause myelopathy, but it can contribute. A forward head position increases the load on the cervical spine and may speed up the wear-and-tear changes that narrow the canal over time.
The price for patients travelling from abroad is confirmed during the free video consultation, and you can find more answers on our FAQs page.
ScanAlign is at 19 Harley Street, London, inside The Harley Street Hospital. Once you are in London, the nearest Underground stations are Oxford Circus and Regent's Park.
Wondering if your neck symptoms are linked to alignment?
A free video consultation with our specialist radiographer can help you understand whether a standing alignment scan would add useful information in your case, before you decide to travel.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Fehlings MG, et al. A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy. Global Spine Journal, 2017;7(3 Suppl):21S-34S.
- NHS. Cervical spondylosis. nhs.uk/conditions/cervical-spondylosis.
- Karadimas SK, et al. Pathophysiology and Natural History of Cervical Spondylotic Myelopathy. Spine, 2013;38(22 Suppl 1):S21-S36.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.