Mild
mJOA 15 to 17
What it means
Function is only slightly affected. Surgery or a closely watched trial of non-surgical care are both reasonable, with surgery if things slip.
Cervical myelopathy: pressure on the spinal cord in your neck
Unlike a pinched nerve, myelopathy is pressure on the spinal cord itself. It often creeps in quietly, as clumsy hands and a slightly unsteady walk, and it tends to progress rather than settle. That is why it is the one neck condition where getting assessed sooner genuinely matters. The good news: surgery is usually very effective at stopping it getting worse.
What you need to know in 30 seconds
Myelopathy is compression of the spinal cord, not a single nerve root. That is what makes it different from radiculopathy.
The early signs are subtle: clumsy hands, dropping things, buttons and keys becoming fiddly, and a less steady walk.
It usually progresses in steps rather than settling on its own, and lost function does not always come back.
Surgery to take the pressure off the cord is usually very good at halting progression, and often improves things.
Because recovery is better the earlier it is treated, this is a condition where a timely opinion is worth it.
It can occur alongside nerve-root pain, so arm pain and hand clumsiness together deserve a careful look.
The cord
Pressure is on the spinal cord itself, not a single nerve. That is the key difference from radiculopathy.
Hands and balance
Clumsy hands and an unsteady walk are the classic early signs, often before much pain.
It progresses
Left alone it tends to worsen in steps over months to years, rather than settle.
Surgery works
Taking the pressure off the cord usually halts progression, and the earlier it is done the better.
WHAT IT IS
The spinal cord squeezed inside a narrowing canal
The spinal cord runs through a bony canal in the middle of your neck. When that canal narrows enough to press on the cord, the signals travelling through it are disrupted. That is cervical myelopathy.
1
Vertebra, one of the seven bones of the neck
2
Disc, the cushion between two vertebrae
3
Spinal cord, running down through the canal
4
Bulging disc and bony spur pressing back
5
Compressed cord, where signals are disrupted
01
Why it is different from a pinched nerve
A pinched nerve root affects one strip of one arm and usually settles. The cord carries the signals for everything below the neck, so when it is squeezed the effects are more widespread, more subtle, and less likely to recover on their own.
02
The signals get scrambled, not just blocked
Because the cord relays information in both directions, compression shows up as a mix: hands that will not do fine tasks, legs that feel less sure, and sensation that is a little off. It rarely presents as one dramatic symptom, which is exactly why it is missed.
03
It is usually a slow, mechanical narrowing
Most often it builds over years from wear and tear and canal narrowing, sometimes on top of a canal that was always on the narrow side. Occasionally a large disc or a ligament problem brings it on more quickly.
WHAT IT FEELS LIKE
Subtle at first, and easy to blame on age
These changes come on gradually and are often put down to getting older or being tired. Noticing the combination, especially hands and balance together, is what leads to the diagnosis.
01
Clumsy hands
Dropping things, fumbling buttons, zips and coins, handwriting getting worse, or struggling with a key in a lock. Often both hands, and often the first thing people notice.
02
An unsteady walk
Feeling less sure on your feet, walking a little wider to stay balanced, or reaching for the handrail on stairs you used to take without thinking.
03
Odd sensations
Numbness or pins and needles in the hands, a feeling that they are not quite your own, or an electric-shock sensation running down the spine when you bend your neck forward.
04
Weakness, and later the bladder
Arms or legs feeling weaker, and in more advanced cases a change in bladder control such as new urgency. These are signs to act on without delay.
WHEN TO ACT
This is the neck condition not to sit on
Nerve pain can usually be given time. Cord compression is different, because function that is lost while waiting does not reliably come back. If several of these fit, it is worth a prompt assessment.
1
Both hands becoming clumsy
Fine tasks getting harder in both hands together, rather than pain in one arm, is a classic cord sign.
2
Balance or walking changing
Feeling unsteady, or noticing you walk more carefully than you used to, without another clear cause.
3
Symptoms getting worse in steps
A pattern of plateaus and step-downs over months, rather than steady improvement, points to progression.
4
An electric feeling down the spine
A shock-like sensation running down the back or into the limbs when you bend your neck forward is worth mentioning.
Seek urgent care
Rapidly worsening weakness or numbness, a sudden decline in walking or hand function, or any new loss of bladder or bowel control needs emergency assessment. Call 000 or go to your nearest emergency department. GPs with an urgent concern can phone the rooms directly on (07) 3870 3708.
WHAT CAUSES IT
Different roads to the same narrowing
Most cases are the cumulative result of age-related change. A few have a distinct cause. Often more than one factor is at work at the same level.
01
Wear and spurs
The most common route. Cervical spondylosis gradually adds bony spurs and thickened ligament that crowd the canal over years.
02
A narrow canal
Some people are born with a canal on the tighter side. It causes no trouble for decades, then leaves less margin when stenosis is added.
03
A large disc
A sizeable central disc herniation can press directly on the cord, sometimes bringing symptoms on faster than the slow degenerative form.
04
Ligament thickening
In some people a spinal ligament hardens and thickens over time, taking up room in the canal. It is a recognised cause that shows up clearly on a scan.
HOW IT IS DIAGNOSED
Examination first, then an MRI to confirm
The diagnosis often starts with signs found on examination that the patient had not connected to their neck. An MRI then confirms the cord is compressed and shows where.
01
Examination signs
Certain reflexes become brisker than normal, and specific tests in the hands and legs point to the cord rather than a single nerve. These often clinch the suspicion before any scan.
02
MRI of the neck
The key test. It shows how much room the cord has, and whether the cord itself shows any change from the pressure. It is the scan the decision is built on.
03
Grading how it affects you
Function is scored on a simple scale so that severity, and any change over time, can be tracked objectively rather than by impression alone.
How severity is graded
Specialists use a score called the mJOA to grade how much the myelopathy is affecting hand use, walking, sensation and bladder. It groups people into three bands, and the band guides how strongly surgery is recommended.
Moderate
mJOA 12 to 14
What it means
Everyday function is clearly affected. Surgery to decompress the cord is recommended, based on international guidelines.
Severe
mJOA 11 or less
What it means
Function is substantially affected. Surgery is recommended, and generally without much delay.
A scan finding of cord compression without any symptoms is a different situation, and does not automatically mean an operation. It does mean the neck is worth keeping an eye on, and worth protecting from injury. The judgement about what a scan actually means for you is the point of the consultation.
WHY WAITING MATTERS
The case for not leaving it too long
This is the honest part, and the reason the tone on this page is different from the others. Left untreated, myelopathy tends to progress, and function lost to cord compression does not reliably return even after the pressure is relieved. The aim is to act before too much is lost.
1 YEAR
About 1 in 16
In studies of untreated cervical myelopathy, roughly 6 per cent had worsened in daily activities by one year.
2 YEARS
About 1 in 5
By two years, around 21 per cent had deteriorated. The trend is gradual, not sudden, which is what makes it easy to miss.
3 YEARS
About 1 in 4
By three years, close to 28 per cent had worsened, and separate studies show many decline by a meaningful amount over three to six years.
10 YEARS
More than half
Over ten years, around 56 per cent had deteriorated. The longer the wait, the higher the chance of a step down.
The upside
Set against that, surgery to decompress the cord reliably halts progression for most people, and international guidelines report clear improvements in function and quality of life after it, with low complication rates. Earlier treatment, before significant loss, gives the best odds of getting function back rather than simply holding the line.
TREATMENT
Taking the pressure off the cord
For mild disease, a closely watched non-surgical trial can be reasonable. For moderate or severe myelopathy, the mainstay is an operation to decompress the cord. The right approach depends on where the pressure is and how many levels are involved.
01
ACDF
Removing a disc and any spur from the front and fusing the level. A workhorse for compression coming from the front at one or two levels. About ACDF.
02
Corpectomy
Removing part of a vertebral body to clear compression that spans a level. Used when a spur or disc sits behind the bone itself.
03
Laminectomy
Removing bone from the back to give the cord room, often over several levels, sometimes with a fusion to keep the neck stable.
04
Laminoplasty
Reshaping the bone at the back to widen the canal while preserving more movement, an option in the right multilevel anatomy.
Which operation, and whether from the front or the back, is matched to your scan and your anatomy, and talked through fully before any decision. If you are weighing it up, do I need neck surgery? sets out how the call is made.
This is the one cervical condition worth acting on rather than watching
Cervical myelopathy tends to progress in steps rather than settle. In natural history studies around 21 per cent had deteriorated by two years and around 56 per cent by ten. Decompression halts progression for most people, and function already lost does not reliably return. That is why clumsy hands and an unsteady walk are taken more seriously here than severe pain is.
COMMON QUESTIONS
The things people ask most
Is cervical myelopathy serious?
It is the neck condition that most warrants a timely opinion, because it tends to progress and lost function may not return. That said, it is very treatable: surgery to decompress the cord usually halts it, and often improves things, especially when done earlier.
How is it different from a pinched nerve?
A pinched nerve root affects one arm and usually settles on its own. Myelopathy is pressure on the spinal cord, tends to affect both hands and walking, and does not reliably recover without treatment. The two can occur together.
Does it always need surgery?
Not always. Mild myelopathy can sometimes be watched closely with surgery if it progresses. For moderate or severe disease, international guidelines recommend surgery to decompress the cord. The mJOA grade helps guide that decision.
Will surgery fix it completely?
The main goal is to stop it getting worse, which surgery usually achieves. Many people also regain function, particularly with earlier treatment. Longstanding, severe loss is less likely to fully reverse, which is the argument for not waiting.
What happens if I do nothing?
Myelopathy tends to progress in steps over months to years. In untreated groups, more than half had deteriorated at ten years. Some people stay stable for long periods, but there is no reliable way to tell in advance who will.
My scan shows cord compression but I feel fine. What now?
Compression on a scan without symptoms does not automatically mean surgery. It does mean the neck is worth monitoring and protecting from injury, and worth a specialist opinion so you know what to watch for.
RELATED CONDITIONS
Closely connected to this one
Cervical spinal stenosis
Narrowing of the canal that reduces the space around the cord. It is the setting in which myelopathy develops.
Read about stenosis ›Cervical spondylosis
Age-related change in the discs and joints of the neck, and the most common source of the spurs that crowd the cord.
Read about spondylosis ›Cervical radiculopathy
A pinched nerve root causing arm pain. Milder, usually self-settling, and can occur at the same time as myelopathy.
Read about radiculopathy ›About this information
This page is general information about the cervical spine. It is not a substitute for an individual assessment and it cannot tell you what is happening in your own neck. Where figures are given, they come from the published research listed below and describe groups of people rather than individuals. Please discuss your own circumstances with your GP or a specialist. More about Dr Tollesson.
References
A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy, AO Spine and the Cervical Spine Research Society, for the mJOA severity bands, treatment recommendations and surgical outcomes.
Degenerative Cervical Myelopathy: Development and Natural History, AO Spine RECODE-DCM, for the natural history and progression figures.
If hands and balance are both slipping, do not wait to see if it passes. It usually does not.
A consultation will tell you whether the cord is compressed and what, if anything, needs doing about it. A GP or specialist referral is needed for a Medicare rebate, and a referral from a general practitioner is valid for twelve months.