Most people equate spinal problems with pain of some kind, such as “sciatica”, a “bad back” or a “bad neck”. We may complain of stiffness, or crunching noises when we move our necks or backs. We don’t , however, think of our spines when we start dropping objects unintentionally or when we notice that our hand writing is becoming less legible. We may resign ourselves to thinking that we’re starting to show our age and we quietly swap our lace-up shoes to velcro fastenings and our buttons for zippers. We drink our tea using both hands to avoid the embarrassing clatter of broken crockery when something slips out of our hand. We start paying more attention to where we are walking, since we are not quite as confident as we once were with our balance. No more navigating ourselves to the toilet at night without switching on the light first – we are more reliant on our eyes and less trusting of our balance. We may struggle to walk confidently in a straight line, as though our legs aren’t listening to our brains.
Anatomically, the nerves in the spine can play a trick on us. If a nerve gets squashed, it hurts, right? We’ve all felt that “dead leg” when we’ve put prolonged pressure on a nerve in a leg by sitting awkwardly, or shooting pain in the forearm when we accidentally hit our funny bone at the elbow (it’s not funny). For the spine, an individual nerve may cause pain after it’s left the spinal cord, which appears to be due to an inflammatory reaction. That’s why steroid injections can provide short-term pain relief, by providing a strong anti-inflammatory effect to calm down the inflammatory nerve pain. For the spinal cord itself, though, this doesn’t appear to be the case. So, when we start getting clumsier and clumsier, there aren’t any clues that make us think about our spinal cord, because there’s usually no pain.
Wear and tear of the spine can cause a slow, gradual pressure on the spinal cord and this doesn’t tend to be associated with pain beyond the aches and pains that we dismiss as part of getting older. The lack of significant pain means that most people have lost a lot of their independence by the time they feel that there is something going on which is more than simply growing old. In medical terminology, the symptoms associated with spinal cord compression are called MYELOPATHY.
These are the sort of symptoms that people with myelopathy tend to experience (this is not an exhaustive list):
Jelly Legs / Walking like a Drunk / Unsteady walking / Wobbly walking / Heavy legs / Rapid Fatiguing weakness of legs or arms/hands / with normal usage / Shooting pain in limbs when flexing the neck / Unintentionally dropping objects (the kitchen crockery isn’t safe!) / clumsy hands / Reducing grip strength / Reduced sensation “like wearing thick socks or gloves” / Deteriorating hand-writing and avoiding buttons and shoe laces as they’re too fiddly
Myelopathy is best caught early, since unfortunately, most myelopathy tends to get worse rather than better over time, so there’s no advantage to sitting out the symptoms and hoping that they will improve. Sciatica, on the other hand, usually gets better over time and it’s a good idea to try to improve the symptoms of sciatica with spinal exercises and paying attention to good spinal posture. The un-coordination and clumsiness of myelopathy, however, is best caught on camera by means of an MRI to see if the problem is caused by the spinal cord.
Sometimes, despite the symptoms of myelopathy being quite significant, the MRI is reassuring and excludes a spinal cord problem. In this instance, it’s a good idea to discuss other possible reasons for the reducing function with the GP, since there are other medical conditions which can mimic myelopathy.
The treatment of spinal cord compression which is causing progressive loss of function is to physically remove the spinal cord compression by means of an operation. The spinal operation will vary, depending on which part of the spine is involved. The purpose of the surgery is to stop any further loss of function – hopefully, the spinal cord is able to improve following surgery, but the surgery cannot directly heal the spinal cord, it simply removes the pressure from the spinal cord to give it the chance to improve itself.
So, for all you people out there who are chastising yourselves for dropping the china, keep an eye on your function. If you think you’re getting clumsier, it may be worthwhile asking for an opinion about your spine to check out whether you’re experiencing symptoms of myelopathy.