Cervical myelopathy: 11 subtle signs to take seriously (and what to expect from treatment)

• It’s not just neck pain: it can affect your hands, balance and gait.
• MRI is the key test for identifying spinal cord compression.
• In moderate to severe cases, surgery is often recommended to stop further decline.
• The earlier it’s treated once it’s progressing, the better the chances of regaining function.
• There are urgent warning signs: worsening weakness, repeated falls, changes in bladder or bowel control.

What cervical myelopathy is (and why it’s not the same as radiculopathy)

“Myelopathy” means dysfunction of the spinal cord. “Cervical” means it occurs in the neck. The most common cause in adults is narrowing of the spinal canal from degenerative changes: bulging discs, arthritis, thickened ligaments and, sometimes, calcification. Together, these can compress the spinal cord and disrupt how it carries signals to the arms and legs.

This differs from radiculopathy (the typical “pinched nerve”), which affects a nerve root and usually causes pain that travels down the arm, tingling in a specific distribution and more localized weakness. Myelopathy, by contrast, can cause more generalized clumsiness, balance problems and changes in the way you walk. In real life, both can coexist, which can make the picture harder to sort out.

One important point: recent estimates suggest degenerative cervical myelopathy may be more common than it’s diagnosed, because many cases are mild or get blamed on “age”, “stress” or “poor posture”. That helps explain why some people take months (or longer) to reach the correct diagnosis.

11 subtle warning signs and typical symptoms

You don’t need to have all 11. Sometimes 2 or 3 that are getting worse is enough. If you recognize yourself here, the key is not to self-diagnose: this is meant to help you know when a medical evaluation is worth pursuing.

1) Clumsiness with the hands (“I keep dropping things”)

Trouble buttoning, writing, using keys or handling a phone. It’s not only about strength: it’s fine coordination.

2) Changes in the way you walk

Slower gait, “short steps”, a sense of stiffness or dragging a foot. It may be more noticeable on stairs or uneven ground.

3) Tripping and falling without a clear reason

Especially if it didn’t happen before. With myelopathy, balance can be affected even without dizziness.

4) An “electric shock” feeling when bending the neck

When looking down, some people feel a shock that travels down the back or into the limbs (Lhermitte’s sign). It’s not exclusive to this condition, but it can be a clue.

5) Diffuse tingling in the hands or arms

More “glove-like” or variable, unlike tingling from a single nerve. It can coexist with neck pain.

6) Weakness that doesn’t fit a single injury

For example, opening jars is hard and your legs also feel “heavy”. Or the weakness changes from one day to the next.

7) Stiffness or spasticity

Legs that feel stiff, cramps or a “tight” sensation when walking. This relates to changes in the spinal cord’s motor pathways.

8) Clumsiness when running or changing direction

Symptoms show up in tasks that need quick coordination: turning, stopping, walking fast.

9) Unusual sensory changes

Numbness in the hands and, sometimes, odd sensations in the trunk or legs. You may notice “strange patches” of sensation.

10) Neck pain with “neurological red flags”

Neck pain on its own is very common and often benign. What raises concern is when it comes with clumsiness, gait changes or progressive weakness.

11) Bladder or bowel changes

New urinary urgency, difficulty starting urination or unusual leakage. It doesn’t always mean myelopathy, but if it appears alongside neurological symptoms, it deserves prompt assessment.

Important: symptoms like clumsiness, unsteadiness or sphincter changes can have other causes (neurological, metabolic, medication-related). A clinical evaluation is essential.

Diagnosis: tests that add value

Medical history and neurological examination

This is the first filter. A clinician looks for patterns: increased reflexes, gait abnormalities, long-tract signs (for example, abnormal responses in the feet) and tests of hand dexterity. Findings can be subtle, but they can be very informative.

Cervical MRI

This is the main test because it shows the spinal cord, discs and ligaments. It can reveal compression and whether there is abnormal signal within the spinal cord, which may be associated with greater impact. Still, imaging must be interpreted alongside symptoms: some people have a narrow canal on MRI without clinical myelopathy.

Dynamic X-rays (flexion-extension)

These help detect instability (abnormal movement) that may influence treatment strategy.

CT scan

This provides bone detail. It helps if calcification is suspected (for example, ligament ossification) or for surgical planning.

Electromyography (EMG) and nerve conduction studies

These don’t “see” the spinal cord, but they help differentiate peripheral problems (carpal tunnel, neuropathies) or associated radiculopathy. They are complementary and do not replace MRI when spinal cord compression is suspected.

Blood tests or other tests if the diagnosis is uncertain

In selected cases, clinicians look for vitamin deficiencies (such as B12), thyroid problems or other conditions that can mimic neurological symptoms.

Treatments: non-surgical and surgical options

The decision depends on severity, progression, functional impact and what the tests show. In degenerative cervical myelopathy, the main goal is to prevent neurological deterioration. Pain matters, but neurological function is the priority.

Non-surgical options (when they may make sense)

• Active monitoring in mild, stable cases: clinical follow-up, education about worsening signs and scheduled reviews.
• Physiotherapy focused on gentle mobility, motor control and strengthening, avoiding forceful maneuvers if significant compression is suspected.
• Pain management with sensible measures: heat, short-term non-opioid analgesia when appropriate, sleep hygiene and graded activity.
• Risk-factor modification: stop smoking, optimize bone health, control diabetes and improve overall fitness.

A key limitation: if myelopathy is moderate or severe, or clearly progressing, clinical guidelines often favor surgery to halt decline. In those cases, conservative treatment rarely “reverses” the compression.

Surgical options (in plain language)

Surgery aims to decompress the spinal cord (give it more room) and, when needed, stabilize the spine. The approach is chosen based on the levels involved, neck alignment, the type of compression (front or back), stability and other anatomical factors.

• Anterior surgery (from the front of the neck): the disc or bony spurs compressing from the front are removed and the spine is stabilized with fusion (arthrodesis) or, in selected cases, disc replacement. It’s often used when only a few levels are involved or when the main problem is in front.
• Posterior surgery (from the back): laminectomy (removing part of the back bone to widen the canal) with or without fusion, or laminoplasty (reshaping the bone to enlarge the canal while preserving more structure). It’s often considered for multi-level compression, depending on alignment and stability.
• Combined surgery: in complex situations (altered alignment, significant compression in multiple planes), more than one approach may be considered.

Useful questions to ask your specialist (without jargon): how many levels are involved? is the compression mainly from the front or the back? is my neck well aligned or tending toward kyphosis? do I need stabilization with fusion? what realistic goals should I expect for walking and hand function?

Benefits vs risks and adverse effects

Expected benefits (realistic)

• Stopping further worsening: in progressive myelopathy, this is often the most important benefit.
• Improved function for some patients: balance, hand dexterity and walking tolerance can improve, especially if treated before deficits are very advanced.
• Pain reduction when there is a mechanical or associated radicular component (not always the primary goal).

Risks and adverse effects (without alarmism, without hiding them)

Complications depend on the approach, the number of levels and personal factors (age, osteoporosis, smoking, other conditions). Still, some adverse effects are worth knowing about:

• Dysphagia (difficulty swallowing) after an anterior approach: one of the most common issues and usually temporary, though a small percentage lasts longer.
• Hoarseness or voice changes: typically temporary.
• Hematoma or wound problems: uncommon, but important given the neck location.
• Infection: uncommon, but possible.
• Neurological injury: rare, but the most concerning risk, which is why planning and monitoring are meticulous.
• Axial neck pain after posterior approaches: can occur and may require rehab and pain management.
• C5 palsy (shoulder weakness) after certain cervical decompressions: described especially after posterior approaches; many people recover over time, though it can be frustrating while it lasts.
• Non-union or hardware problems when fusion is performed: risk increases with smoking, poor bone quality and other factors.

A balanced message: in moderate to severe myelopathy, the risk of not treating (progression and loss of function) may outweigh surgical risks. In mild, stable cases, the balance may be different. The key is individualized decision-making.

Referral criteria and when to seek prompt assessment

Consider a prompt evaluation (not to scare you, but to avoid losing time) if any of these apply:

• Progressive worsening of hand dexterity (over weeks to months).
• Unsteadiness when walking, tripping or repeated falls.
• Weakness that increases or spreads to more areas.
• New bladder or bowel changes alongside neurological symptoms.
• Neck pain with clear neurological signs (clumsiness, gait changes, very brisk reflexes).

If you already have an MRI report mentioning “stenosis” or “spinal cord compression”, but your symptoms are changing, don’t dismiss it as “they’ll look at it eventually”. Myelopathy can progress in steps.

Realistic recovery timelines

Recovery after surgery for cervical myelopathy is not linear and is usually measured in months. It also helps to separate two things: wound recovery and neurological recovery.

First 2 weeks

• Goal: control pain, walk daily, basic posture habits.
• Normal: fatigue, stiffness, mild swallowing discomfort if the approach was anterior.

From 2 to 6 weeks

• Goal: increase walking tolerance, gentle mobility, start physiotherapy if recommended.
• Work: for sedentary jobs, sometimes between 2 and 6 weeks (highly variable).

From 6 to 12 weeks

• Goal: strength and balance. Some patients notice gait improvement.
• Activities: gradual progression; avoid sudden spikes in load.

From 3 to 12 months

• This is often when much of the neurological recovery (walking, hand function) settles in, with individual variability.
• If fusion was performed, healing and stability are monitored.

Factors that matter: how long symptoms were present before treatment, initial severity, age, bone health and spinal cord findings on MRI. It’s not a race, it’s a rehab process with realistic goals.

When to go to the emergency department

Go to urgent care (or call emergency services) if any of the following occurs:

• Weakness that worsens quickly (over hours to a few days).
• Loss of bladder or bowel control or acute urinary retention.
• Repeated falls with worsening neurological symptoms.
• After a fall or accident: significant neck pain with new tingling, weakness or clumsiness.
• After recent surgery: high fever, severe disproportionate neck pain, breathing difficulty or progressively increasing neck swelling.

Myths and realities

• Myth: “If it doesn’t hurt much, it can’t be serious.” Reality: myelopathy can cause little pain and still affect hands or gait.
• Myth: “It’s just aging.” Reality: wear-and-tear is common, but progressive loss of function should not be normalized.
• Myth: “Physiotherapy decompresses the spinal cord.” Reality: physiotherapy can help function and pain, but it doesn’t remove significant compression.
• Myth: “Surgery always makes things worse.” Reality: every surgery carries risks, but when indicated it can stop decline and improve function.

FAQs

Is cervical myelopathy reversible?

Sometimes part of the function returns, especially if treated before damage is advanced. However, it doesn’t always go back completely “to how it was”. That’s why the focus is on stopping progression and gaining as much function as possible.

Which test confirms the diagnosis?

The combination of a neurological exam and a cervical MRI is usually the foundation. Other tests (CT, dynamic X-rays, EMG) help complete the assessment and plan treatment.

When is surgery recommended?

Often when myelopathy is moderate or severe, or when there is clinical progression. In mild, stable cases, active monitoring and conservative treatment with close follow-up can be considered.

Does surgery get rid of neck pain?

It can improve pain if part of it is related to compression or instability, but the main goal in myelopathy is neurological (walking, hands, stability). Some people continue to have mechanical pain, treated with rehab and habits.

How long until I notice improvement?

The incision heals over weeks. Neurological improvement, when it happens, is usually gradual over months. Some functions (balance, gait) can take longer than relief from radicular pain.

Can it worsen suddenly?

It can progress in “steps” or accelerate after a fall or in certain situations. That’s why urgent warning signs and re-evaluation with rapid changes are recommended.

Is it the same as “cervical stenosis”?

Stenosis is narrowing of the canal. You can have stenosis without myelopathy. We talk about myelopathy when that narrowing causes spinal cord dysfunction (neurological symptoms and signs).

What can I do while I’m waiting to be assessed?

Avoid activities that increase fall risk, protect your sleep and keep gentle activity (walking) if it’s safe. If you notice rapid worsening, marked weakness or bladder/bowel changes, seek urgent care.

Glossary

Myelopathy

Impaired function of the spinal cord.

Radiculopathy

A problem affecting a nerve root; it usually causes radiating pain and tingling in a specific distribution.

Stenosis

Narrowing of the spinal canal.

Decompression

Surgery to create space and relieve pressure on the spinal cord or nerves.

Fusion (arthrodesis)

Surgery that joins segments to stabilize them, using a bone graft and sometimes screws and plates.

Laminoplasty / laminectomy

Posterior techniques to enlarge the cervical canal by reshaping or removing bony structures.

C5 palsy

Weakness of the deltoid and/or biceps after some cervical surgeries; it often improves over time.

References

1. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy (Global Spine Journal). https://pmc.ncbi.nlm.nih.gov/articles/PMC5684844/ (2017)
2. Degenerative cervical myelopathy (BMJ). https://www.bmj.com/content/360/bmj.k186 (2018)
3. Most degenerative cervical myelopathy remains undiagnosed (review). https://pmc.ncbi.nlm.nih.gov/articles/PMC9813047/ (2022)
4. Degenerative cervical myelopathy: Past, Present, Future (review). https://www.mdpi.com/2077-0383/9/2/535 (2020)
5. Perioperative Complications of Surgery for Degenerative Cervical Myelopathy. https://pmc.ncbi.nlm.nih.gov/articles/PMC9972283/ (2021)
6. Degenerative cervical myelopathy: timing of surgery (EFORT Open Reviews). https://pmc.ncbi.nlm.nih.gov/articles/PMC12139713/ (2025)