What Is Cervical Myelopathy? Causes, Symptoms, Diagnosis and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Quick Answer
Cervical myelopathy is pressure on the spinal cord in the neck, usually from age-related wear of the bones, disks and ligaments that narrows the spinal canal, though injuries, tumors and herniated disks can also cause it. [4] Mild cases are treated with neck braces, physical therapy and medications, while severe cases need decompression surgery such as laminectomy or spinal fusion. [4]
Key takeaways
Cervical myelopathy is painful compression of the spinal cord in the neck, caused by anything that puts pressure on that part of the cord. [4]
Cervical spondylotic myelopathy, the most common form, develops as bones, disks, and ligaments thin or lose flexibility with age. [4]
Symptoms include persistent neck pain, numbness and tingling in the hands and arms, muscle weakness, balance problems, and difficulty with fine motor skills. [4]
Left untreated, the condition can progress to severe pain, bowel and bladder dysfunction, nerve damage, and paralysis. [4]
Mild cases are managed without surgery. Severe cases are treated with decompression surgery such as diskectomy, laminectomy, or spinal fusion. [4]
What the research says
Surgery tends to do better once myelopathy is moderate or severe. A systematic review screened 54 citations and found 5 studies (reported in 6 articles) comparing nonoperative treatment or observation with surgery. One randomized trial gave low-quality evidence that nonoperative care may be equivalent or better than surgery in mild myelopathy, while two cohort studies found that nonoperative treatment had inferior outcomes in moderate to severe myelopathy, even though the surgical patients started out worse. The authors recommend against routinely using nonoperative treatment as the main approach for moderate to severe myelopathy (Rhee et al., Spine, 2013). [1]
Even in mild cases, most people in a Canadian cohort ended up having surgery. Among 122 people with mild cervical spondylotic myelopathy, 105 (86.0%) were treated surgically and 17 (14.0%) nonoperatively. Those who had surgery had worse baseline quality-of-life scores, and a lower EQ-5D score was linked to choosing surgery (P < 0.018). The authors note that surgery has not been shown to be superior to best conservative management in mild disease, so a trial of conservative care is an acceptable alternative (Bond et al., Spine, 2019). [2]
It is common, and surgery rates are rising. Myelopathy from spine degeneration is estimated to affect at least 41 people per million each year (incidence) and 605 per million at any time (prevalence) in North America. Hospitalizations for cervical spondylotic myelopathy have been estimated at 4.04 per 100,000 person-years, and it is the most common cause of spinal cord impairment in adults (Nouri et al., Spine, 2015). [3]
What Is Cervical Myelopathy?
We all have mornings when we wake up with a stiff neck. Cervical myelopathy is different: it causes pain that doesn't go away, and it may make your hands feel numb or weaken your arm muscles.
The spinal cord is the main information highway between your brain and your body. In your neck, it passes through a bony channel formed by the cervical vertebrae. When something presses on the cord in that channel, the pressure disrupts nerve signals traveling up and down the cord, and that disruption is what produces the symptoms.
Any of three general problems can put this pressure in place: an injury that damages the neck structures, a tumor that grows into the canal, or a herniated disk that bulges out of its normal position. [4] In all cases, the mechanism is the same: physical pressure against the cord in the neck region.
A healthcare provider can offer treatment options, including surgery to decompress the spinal cord, which relieves the pressure and helps prevent complications. [4]
What Is Cervical Spondylotic Myelopathy?
The most common type of cervical myelopathy is cervical spondylotic myelopathy, also called degenerative cervical myelopathy. [4] This form develops as you get older and your bones, disks, and ligaments become thinner or lose flexibility and strength. [4]
This process is called spinal degeneration. As degenerative changes narrow the spinal canal, the opening where the spinal cord sits, the canal puts pressure on the spinal cord. [4] These degenerative changes are a natural part of getting older, similar to the wear that accumulates on any heavily used structure.
How common is it?
Cervical spondylotic myelopathy is the most common type of cervical myelopathy. In the United States, between 15,000 and 20,000 people visit the hospital each year with symptoms of the condition. [4]
What Does Cervical Myelopathy Feel Like?
The symptoms of cervical myelopathy reflect disrupted signals in the cord itself, which is why they can appear far from the neck.
Symptom | What it looks like |
Neck pain or stiffness | Pain that doesn't go away, unlike a routine stiff neck |
Numbness or tingling in hands and arms | Pins-and-needles sensations, loss of feeling |
Muscle weakness in hands and arms | Reduced grip strength, dropping objects |
Loss of balance and difficulty walking | Unsteady gait, high risk of falls |
Difficulty with fine motor skills | Trouble buttoning a shirt or holding silverware |
Why does cervical myelopathy affect the legs?
It seems strange that pressure in the neck would affect the legs, but the spinal cord supports nerves that send signals throughout the entire body, and these nerves work as a connected network. Compression in your neck may affect the signals sent by nerves in the lower part of the spinal cord that control your legs. [4] That is why balance loss and walking difficulty are classic symptoms of a neck problem.
What Causes Cervical Myelopathy?
Compression or pressure against the spinal cord in the neck region is the underlying cause. The table below summarizes the common sources of that pressure.
Cause | How it compresses the cord |
Bone spurs | Jagged overgrowths of bone narrow the canal |
Herniated disk | Disk material bulges out and presses on the cord |
Narrow cervical canal | A birth defect leaves a naturally tight canal |
Rheumatoid arthritis | Joint inflammation and deformity crowd the canal |
Spondylolisthesis | A vertebra slips out of position and presses on the cord |
Spinal degeneration | Age-related thinning and stiffening narrow the canal |
Spinal stenosis | General narrowing of the spinal canal |
Traumatic injury | Fracture or dislocation directly compresses the cord |
Tumor | A growth occupies space in or around the canal |
Cervical spondylotic myelopathy specifically happens due to age-related changes that affect the structure and function of the parts of your spine in your neck.
Who Is at Risk?
Cervical myelopathy can affect anyone at any age. Studies show it is more common among people of Asian descent older than 30 years. [4]
Cervical spondylotic myelopathy can also affect anyone, but it is more common among males and adults after age 40. The average age of diagnosis is 64 years. [4]
What Are the Complications?
If left untreated, cervical myelopathy symptoms may get worse. [4] Potential complications include:
Severe pain
Bowel and bladder dysfunction
Nerve damage
Difficulty walking, with instability and a high risk of falls
Limited use of your fingers, hands and arms
Paralysis
This is why early evaluation matters. Symptoms can get worse if the condition is left untreated.
How Is Cervical Myelopathy Diagnosed?
A healthcare provider diagnoses cervical myelopathy after a physical exam, a neurological exam, and other testing. During the exams, your provider reviews your symptoms and medical history. They may test your balance, reflexes and dexterity, and observe you walking (if possible) to understand how the symptoms affect you. [4]
Imaging tests then let the provider look directly at the spine:
Test | What it shows |
X-ray | Bone alignment, bone spurs, and degenerative changes |
MRI | Detailed pictures of the cord, disks, and soft tissues |
CT scan | Fine bone detail and canal dimensions |
Myelogram | Contrast-enhanced view of the cord and canal |
Can Cervical Myelopathy Be Cured?
There isn't a cure available for all causes of cervical myelopathy. Surgery can decrease symptoms and prevent complications. [4] Even after treatment, age-related changes may affect more than one area of your spine.
How Is Cervical Myelopathy Treated?
There are two routes of treatment: nonsurgical management and surgical treatment. Your provider will likely start with nonsurgical options before considering surgery, but this could vary based on the severity of your symptoms and what is causing them. [4]
Nonsurgical management
A healthcare provider may recommend nonsurgical options to help you manage mild cervical myelopathy:
Option | Purpose |
Neck brace | Stabilizes and supports the neck |
Physical therapy | Restores movement and strength safely |
NSAIDs | Reduce inflammation and pain |
Corticosteroids | Reduce inflammation around the cord |
Pain relievers | Manage discomfort |
Nonsurgical treatment addresses immediate symptoms, but it doesn't provide long-term relief. [4]
Surgical treatment
Your healthcare provider may recommend surgery to decompress your spinal cord in severe cases. You may be a candidate for surgery if you have severe pain, muscle weakness, numbness, balance and walking challenges, or difficulty with fine motor skills. [4]
The procedure a surgeon recommends can vary based on your symptoms, general health and age. [4] It may include one or a combination of the following:
Procedure | What it does |
Diskectomy | Removes the disk material pressing on the cord |
Disk replacement | Removes the damaged disk and inserts an artificial one |
Laminectomy | Removes part of the vertebra to widen the canal |
Laminoplasty | Creates more room by hinging the canal open |
Spinal fusion | Joins vertebrae together to stabilize the spine |
Your surgeon will explain the possible risks before the procedure so you can make an informed decision about your health. After surgery, you'll need to take it easy as you recover. Avoid heavy lifting or strenuous activities until your provider tells you they're safe, and follow your surgeon's specific instructions on self-care and follow-up visits. [4]
What's the Outlook?
Your outlook depends on the cause. Mild cases of cervical myelopathy that improve with nonsurgical management usually have a positive outcome after surgical treatment. [4]
Cervical myelopathy can get worse if left untreated. Severe cases may cause permanent, irreversible nerve damage, which can lead to complications like intense pain and difficulty moving. [4] Let a healthcare provider know right away if you have symptoms of cervical myelopathy.
Life expectancy: mild cases don't affect your life expectancy, but symptoms can affect your quality of life. [4] Severe cases can lead to permanent nerve damage or complications like paralysis. [4] Each person's outlook varies based on many factors, including general health and age. Your healthcare provider can give you the best information about your situation.
Living With Cervical Myelopathy
Visit a healthcare provider if you notice symptoms of cervical myelopathy. They may run tests to determine whether there is compression on your spinal cord.
If you have cervical myelopathy, let your provider know if the symptoms you experience get worse or if you notice side effects of treatment.
Your spinal cord has an important job in your body. Unpredictable things, like an accident or natural changes that happen as you age, can put pressure on your spinal cord. Like a bridge in a busy town, wear and tear is unavoidable. Your body needs maintenance and care in the same way a city's infrastructure does to make sure vital parts have the support they need to function.
Conclusion
Cervical myelopathy is pressure on the spinal cord in the neck, most often from age-related changes, but sometimes from injury, a herniated disk, or a tumor. Because the spinal cord is your body's main signal highway, compression in the neck can affect your hands, arms, legs, balance, and even bowel and bladder control. The good news is that providers have effective tools: braces, therapy, and medications for mild cases, and decompression surgery for severe ones. If you notice persistent neck pain with numbness, weakness, or trouble walking, don't wait it out. Get evaluated early, before the pressure causes lasting nerve damage.
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Frequently Asked Questions
What is cervical myelopathy?
Cervical myelopathy is compression of the spinal cord in your neck. It can happen if an injury, tumor, or herniated disk puts pressure on that part of your spinal cord.
Is cervical myelopathy the same as a stiff neck?
No. A stiff neck from sleeping awkwardly usually goes away. Cervical myelopathy causes pain that doesn't go away, and it may make your hands feel numb or cause muscle weakness.
What is cervical spondylotic myelopathy?
Cervical spondylotic myelopathy is the most common type of cervical myelopathy. It happens as you get older and your bones, disks, and ligaments become thinner or lose flexibility and strength, narrowing the spinal canal and pressing on the cord.
What is degenerative cervical myelopathy?
Degenerative cervical myelopathy is another name for cervical spondylotic myelopathy. It is caused by age-related changes (spinal degeneration) that narrow the spinal canal and put pressure on the spinal cord.
Why does my spinal canal narrow with age?
As you age, your bones, disks, and ligaments become thinner or lose flexibility and strength. These degenerative changes narrow the spinal canal, the opening where your spinal cord sits.
Is spinal degeneration a normal part of aging?
Yes. Degenerative changes in the spine are a natural part of getting older, though they can cause problems when they put pressure on the spinal cord.
How common is cervical myelopathy?
Cervical spondylotic myelopathy is the most common type. In the United States, 15,000 to 20,000 people visit the hospital each year with symptoms of cervical spondylotic myelopathy.
What are the main symptoms of cervical myelopathy?
The main symptoms include neck pain or stiffness, numbness or tingling in the hands and arms, muscle weakness in the hands and arms, loss of balance, difficulty walking, and difficulty with fine motor skills like buttoning a shirt or holding silverware.
Why do my hands go numb with a neck problem?
The spinal cord supports nerves that send signals throughout your entire body. Compression in your neck disrupts those signals, which can cause numbness or tingling in the hands and arms.
Why does cervical myelopathy affect my legs?
Your spinal cord supports nerves that send signals throughout your entire body, and nerves work in a connected network. Compression in your neck may affect the signals sent by nerves in the lower part of the spinal cord that control your legs.
Can cervical myelopathy cause balance problems?
Yes. Loss of balance and difficulty walking are classic symptoms because cord compression affects the nerve signals that control your legs.
Why do I have trouble buttoning a shirt?
Difficulty with fine motor skills, like buttoning a shirt or holding silverware, is a recognized symptom of cervical myelopathy caused by disrupted signals to your hands and fingers.
What causes the pressure on my spinal cord?
Compression or pressure against the spinal cord in your neck region causes cervical myelopathy. Common causes include bone spurs, a herniated disk, a narrow cervical canal, rheumatoid arthritis, spondylolisthesis, spinal degeneration, spinal stenosis, traumatic injury, or a tumor.
Can a bone spur cause cervical myelopathy?
Yes. Bone spurs are among the common causes of compression against the spinal cord in your neck.
Can a herniated disk cause cervical myelopathy?
Yes. A herniated disk can put pressure on the spinal cord in your neck region.
Can I be born with a narrow spinal canal?
Yes. A narrow cervical canal can be a birth defect that predisposes you to cord compression.
Can rheumatoid arthritis cause cervical myelopathy?
Yes. Rheumatoid arthritis is listed among the common causes of compression against the spinal cord in the neck.
What is spondylolisthesis?
Spondylolisthesis is when a vertebra slips out of its normal position. It is one of the common causes of compression that leads to cervical myelopathy.
What is spinal stenosis?
Spinal stenosis is narrowing of the spinal canal. It is one of the common causes of compression against the spinal cord in your neck.
Can an injury cause cervical myelopathy?
Yes. Traumatic injury is a recognized cause of compression against the spinal cord in the neck region.
Can a spinal tumor cause cervical myelopathy?
Yes. A tumor is one of the common causes that can put pressure on your spinal cord.
Who gets cervical myelopathy?
Cervical myelopathy can affect anyone at any age. Studies show it's more common among people of Asian descent older than 30 years.
Am I at higher risk for cervical spondylotic myelopathy?
Cervical spondylotic myelopathy can affect anyone, but it is more common among males and adults after age 40. The average age of diagnosis is 64.
What happens if cervical myelopathy goes untreated?
If left untreated, symptoms may get worse. This might cause severe pain, bowel and bladder dysfunction, nerve damage, difficulty walking with a high risk of falls, limited use of your fingers, hands and arms, and paralysis.
Can cervical myelopathy cause paralysis?
Yes. If left untreated, severe cases can lead to paralysis. This is why early evaluation and treatment are important.
Can cervical myelopathy affect my bowel or bladder?
Yes. Bowel and bladder dysfunction is a recognized complication when the condition goes untreated.
How is cervical myelopathy diagnosed?
A healthcare provider diagnoses it after a physical exam, a neurological exam, and other testing. They review your symptoms and medical history, test your balance, reflexes and dexterity, and observe you walking.
What imaging tests are used?
Imaging tests may include X-ray, MRI, CT scan, and myelogram to look at your spine.
Is there a cure for cervical myelopathy?
There isn't a cure available for all causes of cervical myelopathy. Surgery can decrease symptoms and prevent complications.
Will age-related changes continue after treatment?
Yes. Even after treatment, age-related changes may affect more than one area of your spine.
What are the nonsurgical treatments?
Nonsurgical options for mild cervical myelopathy include wearing a neck brace, participating in physical therapy, and taking medications such as NSAIDs, corticosteroids, or pain relievers.
Do nonsurgical treatments fix the problem?
No. Nonsurgical treatment addresses immediate symptoms, but it doesn't provide long-term relief.
When do I need surgery?
You may be a candidate for surgery if you have severe pain, muscle weakness, numbness, balance and walking challenges, or difficulty with fine motor skills.
What surgeries treat cervical myelopathy?
Surgical options include diskectomy, disk replacement, laminectomy, laminoplasty, and spinal fusion. Your provider may recommend one procedure or a combination, depending on your symptoms, general health and age.
What is a diskectomy?
Diskectomy is a surgery that removes disk material pressing on the spinal cord.
What is cervical artificial disk replacement?
Disk replacement removes the damaged disk and inserts an artificial one, preserving movement in that segment of the spine.
What is a laminectomy?
Laminectomy removes part of the vertebra to decompress the spinal cord and widen the canal.
What is a laminoplasty?
Laminoplasty creates more room for the spinal cord by opening the canal like a hinge.
What is spinal fusion?
Spinal fusion joins vertebrae together to stabilize the spine after decompression.
What should I do after surgery?
After surgery, you'll need to take it easy as you recover. Avoid heavy lifting or strenuous activities until your provider tells you they're safe, and follow your surgeon's specific instructions.
What is the outlook for mild cervical myelopathy?
Mild cases that get better with nonsurgical management usually have a positive outcome after surgical treatment.
Does cervical myelopathy affect life expectancy?
Mild cases don't affect your life expectancy, but symptoms can affect your quality of life. Severe cases can lead to permanent nerve damage or complications like paralysis. Outlook varies based on many factors, including general health and age.
Can nerve damage from cervical myelopathy be reversed?
Severe cases may cause permanent, irreversible nerve damage. This is why providers recommend letting a healthcare provider know right away if you have symptoms.
What questions should I ask my healthcare provider?
Good questions include: Where in my neck is compression happening? What type of treatment do you recommend? What are the side effects of treatment? Do I need surgery? And what's my recovery time after surgery?
When should I see a healthcare provider?
Visit a healthcare provider if you notice symptoms of cervical myelopathy. They may run tests to determine if there's compression on your spinal cord.
What if my symptoms get worse after treatment?
If you have cervical myelopathy, let your provider know if the symptoms you experience get worse or if you notice side effects of treatment.
Related Reading
Deep Tendon Reflexes (DTRs): How They're Tested, Graded and What Abnormal Reflexes Mean explains how reflexes are tested and graded with a reflex hammer.
References
Rhee JM, Shamji MF, Erwin WM, et al. Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S55-S67. PMID: 23963006. https://doi.org/10.1097/BRS.0b013e3182a7f41d
Bond M, McIntosh G, Fisher C, et al. Treatment of mild cervical myelopathy: factors associated with decision for surgical intervention. Spine (Phila Pa 1976). 2019;44(22):1606-1612. PMID: 31205181. https://doi.org/10.1097/BRS.0000000000003124
Nouri A, Tetreault L, Singh A, et al. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976). 2015;40(12):E675-E693. PMID: 25839387. https://doi.org/10.1097/BRS.0000000000000913
Cleveland Clinic. Cervical Myelopathy (Cervical Spondylotic Myelopathy). Cleveland Clinic Health Library. Last updated June 26, 2024. https://my.clevelandclinic.org/health/diseases/cervical-myelopathy
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions about a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read here. Seek urgent care right away for worsening weakness, trouble walking, or loss of bowel or bladder control.
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