Cervical Myelopathy: Spinal Stenosis Symptoms and When Surgery Is Needed

When your neck starts to feel stiff and your hands suddenly feel clumsy-like you can’t button a shirt or drop things without meaning to-it’s easy to blame aging. But if those symptoms keep getting worse, especially with balance issues or trouble walking, it could be something more serious: cervical myelopathy. This isn’t just a sore neck. It’s the spinal cord in your neck being squeezed, and if left untreated, it can lead to permanent nerve damage.

What Exactly Is Cervical Myelopathy?

Cervical myelopathy happens when the spinal cord in your neck gets compressed. The most common cause? Cervical spinal stenosis-the narrowing of the bony canal that protects your spinal cord. Think of it like a tunnel that’s slowly shrinking. Over time, bone spurs grow, discs flatten, ligaments thicken, and the space for your spinal cord gets tighter. When that space drops below 13mm, you’re in stenosis territory. At 10mm or less, the cord is under serious pressure.

This isn’t rare. About 9% of people over 70 have it. It’s the leading cause of spinal cord problems in adults over 55. The main type is cervical spondylotic myelopathy (CSM), which makes up 75% of cases. It’s not caused by trauma. It’s wear and tear-slow, silent, and progressive.

What Do the Symptoms Actually Feel Like?

Symptoms don’t always start with pain. In fact, many people have no neck pain at all. The real red flags are neurological:

• Hand clumsiness-dropping utensils, struggling with buttons, fumbling keys
• Gait instability-feeling unsteady walking, especially in the dark or on uneven ground
• Numbness or tingling in hands and arms
• Weakness in arms or legs
• Increased reflexes-your doctor might notice your knee jerk is too strong during an exam
• Bowel or bladder issues-urgency, or worse, incontinence, which signals advanced damage

A study of over 1,200 patients found that 72% reported hand clumsiness as their first noticeable symptom. Around 68% had trouble with walking. These aren’t vague complaints-they’re measurable signs of spinal cord dysfunction. If you’re over 55 and notice any of these, especially if they’re getting worse, don’t wait.

How Is It Diagnosed?

You can’t diagnose this with an X-ray alone. Many people have stenosis on imaging but no symptoms. The key is linking physical signs with imaging results.

The gold standard is an MRI. It shows not just the narrowing, but also whether the spinal cord itself is damaged. Look for T2-weighted hyperintensity-a bright spot on the scan that tells doctors the cord is injured. MRI is 97% accurate at spotting this.

Doctors also use the Japanese Orthopaedic Association (JOA) score. It’s a 17-point test that checks your arm strength, leg function, sensation, and bladder control. A score below 14 means you have myelopathy. It’s not just a formality-it helps track progress and decide if surgery is needed.

CT scans and EMG tests can help too, especially if MRI isn’t possible. But if your doctor only orders an X-ray and says it’s ‘just arthritis,’ get a second opinion. You need an MRI to confirm spinal cord involvement.

When Is Surgery the Right Choice?

Conservative treatment-physical therapy, NSAIDs, activity changes-works for a small group. Only about 28% of mild cases improve over two years. The rest? 63% get worse.

If your JOA score is below 12, or if symptoms are getting worse fast, surgery is the standard of care. The American Academy of Orthopaedic Surgeons gives this a strong recommendation based on high-quality evidence.

Why? Because once the spinal cord is damaged, it doesn’t heal well. The longer you wait, the less likely you are to recover fully. Studies show patients who have surgery within six months of symptoms start have 37% better recovery than those who wait over a year. Every month of delay cuts your recovery potential by about 3%.

What Are the Surgery Options?

There are three main types of surgery, chosen based on where the compression is and how many levels are affected.

Anterior approaches: The surgeon works from the front of the neck. Common procedures:

• ACDF (Anterior Cervical Discectomy and Fusion): Removes the damaged disc and fuses the vertebrae. Works great for one or two levels. 85-90% of patients see improved strength and function. But there’s a 5-7% risk of needing another surgery nearby within 10 years.
• Cervical Disc Arthroplasty (Artificial Disc): Removes the disc but replaces it with a moving implant. Preserves neck motion. The M6-C disc, approved in 2023 for two- or three-level use, shows 81% success at preserving movement after two years.

Posterior approaches: The surgeon works from the back of the neck. Used when compression is widespread or the spine is misaligned.

• Laminectomy: Removes the back part of the vertebrae to open up space. Often combined with fusion for stability.
• Laminoplasty: Hinges the back bone open like a door instead of removing it. Less bone removal, less neck pain afterward. Success rate: 82% for multi-level cases.

Each approach has trade-offs. ACDF gives faster relief for single-level disease. Laminoplasty is better for multiple levels and preserves motion. Fusion gives stability but reduces flexibility. Your surgeon will pick based on your spine’s shape, number of affected levels, and overall health.

What Can You Expect After Surgery?

Hospital stays are short-usually 1 to 3 days. Most people start walking the day after surgery.

Recovery takes time. It’s not like a broken bone. Nerves heal slowly. Full recovery can take 3 to 6 months. About 82% of patients report better hand function after a year. But only 65% regain normal walking ability. Around 28% still need a cane or walker.

Physical therapy is non-negotiable. 85% of patients need 8 to 12 weeks of formal rehab-focusing on balance, core strength, and fine motor skills. Skipping therapy cuts your recovery chances in half.

Common side effects include temporary trouble swallowing (22% after anterior surgery) and neck pain (35% after fusion). Some develop chronic pain after posterior surgery-called post-laminectomy syndrome. It’s not failure, but it’s something to prepare for.

Why Timing Matters More Than You Think

The biggest mistake people make? Waiting. Too many patients see three or more doctors before getting the right diagnosis. The average delay? 14 months.

By then, the spinal cord has been compressed for over a year. Nerve cells die. Scar tissue forms. Recovery becomes harder.

Patients who get surgery within six months of symptoms start are 2.7 times more likely to have an ‘excellent’ outcome on the JOA scale than those who wait over a year. That’s not a small difference. That’s life-changing.

If you’re experiencing hand clumsiness, balance issues, or unexplained weakness, don’t wait for it to get worse. Get an MRI. See a spine specialist. Don’t let ‘maybe it’ll get better’ cost you your independence.

What About the Risks?

Surgery isn’t risk-free. About 4-6% of patients have major complications: nerve injury, infection, or bleeding. One specific risk is C5 palsy-weakness in the shoulder or arm after surgery. It happens in up to 10% of cases but often improves over months.

There’s also a 1-2% chance of neurological worsening after surgery. That’s why patient selection matters. Surgeons who do more than 50 cervical procedures a year have 32% fewer complications. Experience counts.

And yes, some surgeries may be unnecessary. Experts warn that 15-20% of current procedures might be overused because of loose diagnostic criteria. That’s why you need clear symptoms, confirmed by MRI and clinical exam-not just a scan showing stenosis.

What’s New in Treatment?

The field is moving fast. Minimally invasive techniques like tubular laminoplasty cut blood loss by 65% and shorten hospital stays by nearly two days. Robotic-assisted surgery is becoming standard for complex cases, improving precision and reducing revision rates.

There’s also exciting research into neuroprotective drugs. The CSM-Next trial is testing riluzole, a drug used in ALS, alongside surgery. Early results show 12% greater improvement in nerve function at six months.

Genetic testing is on the horizon too. Certain gene variants, like COL9A2, are linked to faster spinal degeneration. In the future, doctors might use these markers to predict who’s at risk and intervene before symptoms even start.

Final Thoughts: Don’t Ignore the Signs

Cervical myelopathy doesn’t come with a warning siren. It creeps in quietly. You might think it’s carpal tunnel, arthritis, or just getting older. But if your hands are losing dexterity, your walk is changing, or you’re feeling off-balance, it’s not normal.

This isn’t a condition you can out-wait. The spinal cord doesn’t regenerate like skin or muscle. Once it’s damaged, the window to fix it closes fast.

If you’re over 55 and noticing these changes, get checked. Don’t wait for a fall. Don’t wait for incontinence. Don’t wait for your doctor to say ‘it’s just aging.’

Early diagnosis. Timely surgery. Proper rehab. That’s the path to keeping your independence.