Numbness, pins and needles sensation on the extremities due to improper working or resting posture are common. However, should they be persistent or associate with clumsiness and poor co-ordination, due attention should be given. They might be early symptoms of cervical myelopathy due to malfunction of the cervical spinal cord.
Cervical myelopathy is a degenerative disease of the cervical spine, usually found in people in the older age group. The spinal canal would be narrowed with aging, because of formation of osteophytes, degenerated cervical discs or hypertrophy of spinal ligaments, resulting in a more restricted space for the cervical spinal cord. Stenosis of the cervical spine would develop as early as the middle age, in patients who smoke and those are born with a small cervical canal. Impingement of the cervical spine will affect the neural tissue and its blood supply, leading to cervical myelopathy: clumsiness in the use of hand, weakness of the extremities, paraesthesia and even difficulties in walking and proneness to falls.
Orthopaedic surgeons will be able to make a preliminary diagnosis from the symptoms and physical signs of the patient. It needs a MRI to confirm the diagnosis of cervical myelopathy and to assess the extent of the compression and degeneration of the cervical spinal cord. If there is already significant disabilities or degeneration of the cervical cord function, decompression surgery to prevent clinical deterioration is recommended. Surgical approach could be either anterior or posterior, widening by laminoplasty or cervical spinal fusion after wide laminectomy. The choice will depend very much on the spinal pathology, the expertise and preference of the operating surgeons. Surgery and an intensive post-operation rehabilitation programme will benefit most patients with cervical myelopathy.
Dr. SUN, Lun-kit