Etiology and therapy of myelopathies

1. Big picture

Myelopathy means disease or dysfunction of the spinal cord. In the exam, the key is not to list every rare cause, but to recognize the spinal cord pattern, localize the lesion, separate it from radiculopathy, polyneuropathy, Guillain–Barré syndrome, cauda equina syndrome, and motor neuron disease, and treat urgent causes before permanent paralysis develops.

The spinal cord has little tolerance for compression, ischemia, abscess, hematoma, or severe inflammation. Therefore, the most important rule is:

Acute or progressive myelopathy = emergency until spinal cord compression is excluded by magnetic resonance imaging (MRI).

The typical clinical combination is:

bilateral motor weakness + sensory level + pyramidal signs below the lesion + bladder/bowel disturbance.