Myelopathy is the gradual loss of nerve function caused by disorders of the spine. Myelopathy can be directly caused by spinal injury resulting in either reduced sensation or paralysis. Degenerative disease may also cause this condition, with varied degrees of loss in sensation and movement.

Spinal cord injury that results in myelopathy is classed as complete or incomplete. The cord does not have to be severed to produce myelopathy. Significant damage to the spine can cause complete paralysis or incomplete paralysis.

Complete myelopathy describes a spinal injury which results in no sensation below the origin of the spinal injury. For example, a person with a spinal injury slightly above the waist would not feel his or her legs, could not walk, would have loss of bladder control and bowel function, and would not have sexual function. This is termed complete because nothing below the injury works. In incomplete myelopathy as a result of spinal injury, considering the same type of injury as above helps explain the distinction. A person in this case might have bladder, bowel, and sexual function, but still not be able to walk. In this type of myelopathy, some functions below the spinal injury may be unaffected or only partially affected.

The most serious complete myelopathy cases are devastating. Injury to the upper areas of the spinal cord can result in myelopathy that affects virtually all systems, causing quadriplegia. The much beloved, late actor Christopher Reeve suffered from this type of myelopathy. He was unable to walk, use his arms, or control functions like breathing without help from a ventilator.

A common cause of myelopathy that is not related to surgical injury is cervical stenosis. When people age, there is a gradual compression and narrowing of the spine. This can result in the spine pinching the surrounding nerves.

Initial signs of cervical stenosis may be heaviness in the legs, pain in the arms, and gradual loss of fine motor skills. A physician evaluating a patient for this type of myelopathy may notice increased muscular structure in the legs and poor coordination when a person walks. Other tests will examine reflexes, which may be abnormal.

Treatment for cervical stenosis with myelopathy is surgery to decompress the spine. The goal of such surgery is to slow down or stop the stenosis from progressing. Unfortunately, this surgery may not provide any relief, and spine surgery is typically complicated. In the elderly, the risks may far outweigh the benefits. If pain is present, the best course is sometimes pain management.

As Christopher Reeve advocated in his lifetime, there is an urgent need for the medical community to address the conditions, such as myelopathy, caused by spinal injury or progressive disease. It remains a wish of almost all people that research continues in this field until we can fix the devastation caused by damage to the spine.