Degenerative Cervical Myelopathy Treatment

Degenerative cervical myelopathy (DCM) is a progressive condition that requires timely intervention to prevent neurological decline. While non-surgical treatments can manage symptoms, they do not stop disease progression, making surgery often necessary to alleviate spinal cord pressure. Below are the primary treatment options for DCM.

Non-surgical: Initial management might include physical therapy, pain management with medications, and lifestyle modifications. However, non-surgical treatments do not stop the progression of the disease.
Surgical: Surgery is often necessary to relieve the pressure on the spinal cord and prevent further neurological decline. Common procedures include decompression surgery (e.g., laminectomy, discectomy) and spinal fusion.

Role of Physical Therapy in DCM Management

Physical therapy plays a significant role in the management of degenerative cervical myelopathy, particularly in the early stages of the condition or as part of a postoperative rehabilitation program. The goal of physical therapy in degenerative cervical myelopathy (DCM) is to help alleviate symptoms, maintain or improve function, and prevent further deterioration.

DCM Symptom Management

Pain Relief: Physical therapists can use modalities such as acupuncture, heat, cold, ultrasound, or transcutaneous electrical nerve stimulation (TENS) to help manage pain.

Muscle Relaxation: Techniques such as gentle stretching and massage may be employed to reduce muscle tension and alleviate discomfort in the neck and upper back.

Improving Mobility

Range of Motion Exercises: Exercises aimed at maintaining or improving the flexibility of the neck and shoulders can help reduce stiffness and improve overall neck movement.

Postural Training: Correcting posture is crucial in reducing strain on the cervical spine, and physical therapists can teach proper posture and ergonomic adjustments for daily activities.

Strengthening and Conditioning

Strengthening Exercises: Physical therapists design specific exercises to strengthen the muscles supporting the cervical spine, which can help stabilize the area and reduce stress on the spinal structures.

Core Strengthening: Strengthening the core muscles (abdominals and back muscles) is also essential to support overall spinal health and reduce the burden on the cervical spine.

Balance and Coordination

Balance Training: Since DCM can affect coordination and balance, physical therapists may incorporate exercises that focus on improving these aspects, which can reduce the risk of falls and improve walking stability.

Gait Training: If walking is affected, gait training exercises can help improve the way a person walks and increases confidence in mobility.

Education and Lifestyle Modification

Activity Modification: Physical therapists educate patients on how to modify activities to reduce strain on the neck and avoid exacerbating symptoms.

Ergonomics: Guidance on proper ergonomics, whether at work or during daily activities, can help prevent further compression of the spinal cord.

Physical Therapy Post-Surgery
For patients who undergo surgery to relieve spinal cord compression, physical therapy is often an essential part of the recovery process. Postoperative physical therapy typically includes:

Gradual Mobilization: Controlled exercises to regain strength and mobility without stressing the surgical site.
Scar Tissue Management: Techniques to minimize the formation of scar tissue and maintain soft tissue mobility around the surgical area.
Functional Training: Exercises designed to help the patient return to daily activities safely and effectively.

DCM Case Study

A woman in her mid-60s with degenerative cervical myelopathy (DCM) came to the clinic with the goal of utilizing a robotic-assisted walking device. Her symptoms, which had begun 20 years before the assessment, included a fixed stiff back and cervical spine, forward head posture, and limited range of motion in her shoulders, making daily tasks like dressing difficult.

It was clear early on that the robotic assisted device was not appropriate for her level of function, and further consultation was needed.

She exhibited myotomal weakness in both the upper and lower extremities, a significant kyphotic thoracic spine, and only ¼ of the cervical spine’s active range of motion in all directions. Neurological signs were present, including positive Babinski and Hoffman’s reflexes, muscle wasting in her hands, and high levels of muscle tone throughout the extremities.

Her gait was severely impaired, relying on a two-wheeled walker with short, shuffling steps and a very slow pace. She also experienced neuropathic pain in her upper and lower extremities. Eventually, symptoms had progressed to urinary and fecal incontinence. It was clear early on that the robotic assisted device was not appropriate for her level of function, and further consultation was needed.

After a few sessions, the therapist referred to a physiatrist for further assessment realizing the serious nature of the client’s deficits. She was then subsequently referred to a neurosurgeon and underwent a C2-C7 spinal fusion five weeks later.

Unfortunately, due to pandemic constraints and other factors the patient was seen two years post-surgery. Physiotherapy treatment consisted of positioning techniques to reduce tone, facilitating postural control, overall strengthening, gait training, and bodyweight support treadmill training.

Over a few months of treatment, significant improvements were observed, including better gait speed, improved gait quality, and improved selective movement in the lower extremities. Despite her condition initially improving with physiotherapy, there was a marked and slow deterioration where the client continues to be monitored by several specialists.

Conclusion

Degenerative cervical myelopathy (DCM) is the most common form of spinal dysfunction in adults. While the signs and symptoms of DCM are variable, it can have significant consequences leading to spinal cord compression and neurological disability.

While physical therapy can be beneficial in managing symptoms and maintaining function, it’s important to note that it does not reverse the underlying spinal cord compression. Therefore, in cases of moderate to severe DCM, where significant neurological impairment is present, surgery may be necessary to prevent permanent damage.

Physical therapy is most effective when combined with a comprehensive treatment plan that may include medical management, lifestyle changes, and, when necessary, surgical intervention.

References

[i] Milligan J, Ryan K, Fehlings M, Bauman C. Degenerative cervical myelopathy: Diagnosis and management in primary care. Can Fam Physician. 2019 Sep;65(9):619-624. PMID: 31515310; PMCID: PMC6741789.

[ii] Degenerative cervical myelopathy, NHS Inform/

[iii] Milligan J, Ryan K, Fehlings M, Bauman C. Degenerative cervical myelopathy: Diagnosis and management in primary care. Can Fam Physician. 2019 Sep;65(9):619-624. PMID: 31515310; PMCID: PMC6741789.

Written by

Kathy MileskiRegistered Physiotherapist and Mindfulness Trainer

Kathy Mileski loves the idea of helping others be as mobile and active as they possibly can. She believes that every person has the potential to do amazing things. That belief bolstered by her training and experience has helped her clients to achieve success in their rehab goals no matter where they are in terms of their recovery.