Whats is Myelomalacia?
Myelomalacia is a spinal cord disorder. The myelomalacia definition, strictly speaking, is the abnormal softening of the spinal cord. After the trauma of an acute injury, bleeding of the spinal cord may occur.1 As a result, there is “subsequent softening of normal tissues”.
Myelomalacia could also be caused by other types of trauma or disease. However, if it worsens, and if the bleeding reaches the cervical region of the body, it can be fatal. Bleeding might end up making the tissue necrotic. Fractured vertebrae can lead to bleeding in the spinal cord, as may some complications from back surgery.
Osteoporosis may also contribute to spinal instability and hemorrhaging.2 Osteoporosis is a condition where patients develop fragility in their bones and experience an increased susceptibility to fracture. It is this weakness that makes it too easy for those with osteoporosis to be at risk for developing myelomalacia. Those who are most at risk to have osteoporosis are those who do not regularly exercise, lack calcium and vitamin D, smoke cigarettes, drink alcohol to excess, have a history of rheumatoid arthritis or bone fractures, and have a genetic family history of osteoporosis. The condition will not be symptomatic until a bone fracture has occurred, though osteoporosis might be found by X-rays and confirmed by a bone density measurement test.3
Sometimes circulatory problems can lead to a deterioration of tissues and bleeding.4 Myelomalacia can progress into impairment in the functioning of the lower extremities, below-normal or absent reflexes of the anus and pelvic limbs, loss of pain perception in the caudal region (near the coccyx), depression, respiratory problems due to “diaphragmatic paralysis”, and even neurological issues.
Death could be the eventual result from the respiratory paralysis if the condition is left to deteriorate to such a dire point. Damage occurs to the central nervous system. At first, the spinal cord damage may be minor. The most commonly injured areas are the lumbar spine (lower back) and cervical vertebrae (upper spine area).5
Myelomalacia: Softening of the Spinal Cord Symptoms and Diagnosis
Some of the early symptoms of this disorder could be hypertension, extremities losing motor functions, or jerking limbs. Later, patients may experience a progression from the lack of reflexes to being unable to feel pain, or they might become paralyzed. These symptoms would indicate that the spinal cord has been damaged or softened. Once the respiratory system is paralyzed, the patient will die.
While the elderly are at risk of myelomalacia due to weakened bones (osteopenia), damage to the spinal cord could happen to anyone. Hemorrhaging may lead to compression, further harming the spinal cord. Athletes can also develop this condition, due to injuries or accidents, such as taking frequent hits or landing on the ground in a harsh manner.6
There is one case of a patient who might have developed myelomalacia as a result of performing Sirsasana poses, or headstands, every day as a part of her regular yoga routine.
While there were no known previous reports of myelomalacia caused by headstands, there are previously reported cases of worsening glaucoma symptoms and central retinal vein occlusion. Over time, patients might have a loss of bladder or bowel control, if not complete paralysis.7 Damage can ascend upward, even if it starts in the lumbar region.
Myelomalacia is often diagnosed with myelography testing or an MRI.8 MRI, or magnetic resonance imaging, is a radiological technique that can view the body’s internal structures. The myelomalacia MRI can show where bone density is lost and could demonstrate the onset or the progression of the myelomalacia in the patient.9 Myelography “uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury”. It uses X-rays.10
Cervical Myelomalacia Causes and Treatment
Cervical myelomalacia is a degenerative spinal condition that is defined as “softening of the spinal cord in the upper spine”. This occurs due to insufficiency in the blood supply that feeds the spinal cord. Cervical myelomalacia causes are aging or sports injuries. It could also be caused as a result of other degenerative spinal conditions.
For patients seeking surgical treatment, “a minimally invasive procedure for cervical myelomalacia does offer a number of benefits over traditional open spine surgery”, but this is still a serious procedure to undergo. A patient’s choice to receive any kind of invasive procedure is an important one that should be seriously considered first. Myelomalacia is a serious condition, though, and surgery is basically the only option for every patient.
The MIS (minimally invasive stabilization) procedures typically are offered to outpatients and involve only a small incision. During the procedure, the bone or disc that is softening or constricting the spinal cord is taken out. In the remaining space, the patient’s stem cells, or an implant or bone graft are inserted to replace the damaged disc. After the surgery, the 4-6 week period following the procedure is very important for rehabilitation purposes. Patients should not overexert, twist, bend or lift, but they should become mobile.11
Early Diagnosis and Surgery for Myelomalacia
It is important to remember that surgery may only slow or stop the damage from Myelomalacia becoming worse, since there is not any treatment known that can reverse myelomalacia’s nerve damage. This is another reason for patients to pay attention to what their body is telling them, as catching myelomalacia early in its progression is key in minimizing long-term damage.12
Surgery is the typically recommended treatment for myelomalacia because a damaged spinal cord does not grow back and recovery is impacted by atrophied and tightened muscles. It is best to remove the damaged part, in this case, before it is allowed to further degenerate the patient’s overall condition. If a patient is of an advanced age, or if they have a health condition that would contraindicate surgery, then this would be a case where they might instead be prescribed steroids to reduce swelling or baclofen (a muscle relaxer) to decrease spasticity. In general, though, these prescriptions, as well as pain medications, are said to be most helpful when combined with surgery. This is one of the cases where surgery is an almost certain course of action that the patient will take.13
Treatment is generally designed to prevent further damage in this condition of advancing deterioration. However, there are cases where myelomalacia can be reversed in the early stages, depending on the severity of the spinal cord damaged. That is why it is important to get an MRI as soon as possible so that the condition can be assessed and managed quickly.14
Furthermore, the MRI is preferred over a CT (computerized tomography) scan, because it is more accurate in demonstrating the “intramedullary abnormalities in the injured spinal cord”, since MRI can “separate myelomalacia from a posttraumatic spinal cord cyst”. It is important to distinguish “prior to surgery, patients with shuntable intramedullary cysts from those with chronically damaged but noncystic spinal cords”. In other words, the MRI gives a more accurate picture than the CT scan in patients with myelomalacia versus those with a “posttraumatic spinal cord cyst”.15
The two goals of surgery to treat myelomalacia are to find what is inhibiting normal blood flow and clear the blockage or correct the compression that is causing this inhibition. Then, the area needs to be stabilized in order to greatly reduce the likelihood of a recurrence of the problem in the future. When the cause of the spinal softening is reduced blood flow, which was in turn caused by a shifted spinal disc, what follows is a basic overview of the operation by which the patient would likely be treated.
General anesthesia would be administered so that the patient falls asleep during the procedure. The surgery, in most cases, should be minimally invasive, which cuts down on the recovery time and reduces the risk of surgical complications. A small incision in the patient’s back at the damaged site will be made, and the cause of the blood flow blockage will be removed. Then, a bone graft will be inserted in the now available space to help stabilize the spine and prevent future disc compression in the area.16
Massage for Pain Relief
While they are not perfect treatment options for myelomalacia, there are some alternative therapies that could help with symptom relief before and after surgery. Patients should consult with their doctors first before seeking additional therapies in order to confirm their safety. Not every patient is physically able to have certain types of treatment. What might help one patient speed up recovery could worsen the condition of another patient.
In one study, a patient with cervical degenerative disc disease experienced chronic symptoms of neck pain, shoulder and arm pain, and limited range of motion. The patient underwent several treatment sessions performed by a massage therapist. During treatment, the patient received soft tissue manipulation through petrissage and neuromuscular techniques, stretching, fascial work, hydrotherapy, and guidance and education for how to continue condition management at home.
It was found that, after several treatment sessions, the patient experienced a decrease in painful symptoms and improvement in range of motion. While this did not fully treat the underlying condition, the massage therapy did improve the patient’s quality of life and ability to perform daily tasks with more ease.17
Tai Chi Poses
Tai chi is another way for patients to condition their minds and bodies for strength and combat ailments to some extent. Originating in and already widely followed every day in China, tai chi may be performed by anyone who can stand up, and there are even adaptations that can be made specifically for patients who are confined to wheelchairs. Patients of almost any age or physical state can practice tai chi, and even athletes who compete in official events use the tai chi forms as a way to improve reflexes and reduce healing time.
Tai chi promotes both mental and physical wellbeing through regulation of the nervous system, toning and releasing knots and tension in muscles, encouraging the release of feel-good chemicals in the brain, and stretching and exercising every part of the body. It is the type of pain relief and strengthening that patients with myelomalacia might find to be very helpful for their condition.18
Yoga for Exercise
Yoga could be another form of exercise discipline that a patient who experiences difficulties with back health might find helpful. It has been found in one Taiwanese study to even reduce degenerative disc disease. Degenerative disc disease is similar to osteoporosis in that it is progressive, worsening with age. Neither osteoporosis nor degenerative disc disease are necessarily an expected part of aging, though the risk of the onset of these conditions does increase over time. It was previously thought that both conditions were an unavoidable aspect of advancing age. However, studies have disproven this theory by showing that older patients who experience no effects of degenerative diseases do widely exist.
Bone strength is strongly related to muscle strength, further proving that regular exercise is very important for the body. It increases the patient’s chance of continuing to live a healthy, pain-free life, even as they continue to advance in years. In the previously mentioned study, the patients practiced a gentle and slow form of yoga as a group, and all of the participants showed significantly less spinal degeneration when compared to the control subjects. The patients who did not participate in the yoga part of the study were of similar age, sex, and states of health to those who did follow the yoga exercises. Yoga stretches the spine and decreases weight-bearing, allowing nutrients to better diffuse into the spinal discs.
Hatha yoga was the style that was performed by the patients in the study.19 Hatha, which literally means “force”, is a branch of yoga. In western culture, hatha yoga is typically understood as “asanas”, or physical posture. Hatha yoga is usually just known as “yoga” when used only for the asanas without following the entire lifestyle of hatha yoga. The practice traditionally extends beyond just physical exertion and exercises to affect other aspects of a practitioner’s lifestyle through ideas of ethics, diet, cleansing, breathing exercises, meditation, and spiritual development.20
1, 5, 6, 9, 12 https://en.wikipedia.org/wiki/Myelomalacia
2, 4, 8 https://www.causes.com/causes/335827-for-truthful-information-about-meningeal-pathologies-sacral-cysts-and-arachnoiditis/updates/432607-myelomalacia-severe-problem-due-to-a-bleeding-in-the-spinal-cord