Jeffrey R. Carlson, MD
The title of this article echoes complaints I often hear from patients in the exam room. Poor balance can be caused or exacerbated by many things – aging, medications, blood pressure, ear infections or disorders, arthritis, circulation issues – the list is long. However, most folks don’t know that a problem in the neck can cause a lack of balance and an increase in falling…this condition is called cervical myelopathy.
Patients with cervical myelopathy can be be misdiagnosed or overlooked. Cervical myelopathy is an arthritic condition of the discs in the neck. As these discs degenerate, they will bulge and compress the nerves and spinal cord. With spinal cord compression, patients will have difficulty using their hands for delicate tasks like sewing, typing, and buttoning. It can also lead to weakness in the arms and legs and loss of balance.
As we get older, the speed of communication between our nerves slows down and we may have difficulty with these tasks, causing patients and their families to attribute this to the aging process. Younger patients may find themselves too busy to seek treatment for this minor inconvenience or chalk up their balance issues to being clumsy. There may be a more serious underlying condition.
A recent study, from the Spring meeting of The Society of British Neurological Surgeons, looked at how long it took for patients with cervical myelopathy to be diagnosed. They collected information from 780 patients with cervical spinal cord compression. These patients related that they were not diagnosed for 1-2 years after their symptoms began. This delay led to greater disability, lower ability to be employed and more dependency on others for support. They all had surgery to correct their spinal cord compression, but the delay in diagnosis led to worse outcomes and recovery.
Surgery is the appropriate treatment for removing the pressure from the spinal cord and allowing the nerve information to flow again. The sooner the surgery can be done, the more likely the spinal cord will recover fully. The opposite is also true, the longer surgery is delayed, the more likely the spinal cord will not recover.
The spinal cord is the conduit for the information that our brain sends to our bodies to perform whatever tasks we need to get done. When there is pressure on the spinal cord, that information slows down and our muscles don’t get the electrical impulses fast enough to perform quickly. This information is constantly flowing to and from our muscles to provide feedback on how much pressure we need to apply, how quickly we need to move and how far we need to reach. This feedback loop normally runs very quickly to keep our movements smooth. When this flow of information is slowed, our ability to respond quickly enough to keep our bodies moving freely also declines. This study is a wake-up call to patients and physicians to be aware of any changes in a patient’s ability to perform fine motor skills or if they experience frequent falls.