Cervical Myelopathy Specialist · Naples & Fort Myers, FL
Cervical Myelopathy. Spinal cord compression in the neck. Progressive. Irreversible if untreated. Treatable when caught in time.
Cervical myelopathy is compression of the spinal cord in the neck — causing hand weakness, balance loss, and gait changes that patients often mistake for normal aging. It is not. The cord cannot recover what it permanently loses. Dr. Katsevman offers every surgical approach available and takes the urgency seriously.
"Myelopathy is the one diagnosis I never want to catch late. The cord gives you warning signs — hand clumsiness, balance changes, the electric shock with neck flexion. Those signs should not be waited on."
Dr. G. Katsevman, MD · Neurosurgeon & Spine SurgeonDr. K performs them all
on every cervical case
Don’t wait for severe deficits
Bring your MRI
Understanding the condition
What is cervical myelopathy?
Cervical myelopathy (also called cervical spondylotic myelopathy, or CSM) is a syndrome caused by compression of the spinal cord within the cervical spinal canal. As the canal narrows from disc degeneration, bone spurs, thickened ligaments, or other degenerative changes, the cord is gradually squeezed — disrupting the neural signals that control movement, coordination, sensation, and autonomic function throughout the body below the level of compression.
It is critically different from radiculopathy, where a nerve root is compressed. Nerve roots can recover. The spinal cord does not. Once myelopathic changes are established in the cord — visible as T2 signal change on MRI — they are largely permanent. Surgery stops further loss. It cannot reverse what the cord has already lost.
Why this diagnosis demands timely action
Cervical myelopathy is frequently missed or misattributed for months to years. Patients are told their hand clumsiness is carpal tunnel, their balance problems are inner ear, their leg stiffness is arthritis. By the time the correct diagnosis is made, cord signal change is often already present on MRI — indicating irreversible injury.
The clinical evidence is clear: patients decompressed before significant MRI cord signal change appears recover significantly better than those decompressed after. The goal of early evaluation is not to rush into surgery — it is to make the decision at the right moment, not after the window has closed.
If you have symptoms consistent with myelopathy, a consultation and MRI are the right next step — not watchful waiting.
Recognizing the warning signs
Symptoms of cervical myelopathy
Myelopathy symptoms are often subtle at first — and frequently attributed to something else. The pattern that should raise immediate concern is progressive dysfunction in the hands, gait, or bladder that cannot be fully explained by peripheral causes alone.
Hand Clumsiness & Fine Motor Loss
The earliest and most characteristic symptom. Difficulty buttoning shirts, handling utensils, writing, typing, or picking up small objects. Patients often notice their handwriting has deteriorated or they are dropping things they would not have dropped before. Frequently misdiagnosed as carpal tunnel syndrome — but carpal tunnel does not cause gait changes or Lhermitte’s sign.
Gait Instability & Balance Loss
Unsteady, wide-based walking — veering to one side, difficulty on uneven ground, trouble navigating stairs, or a feeling that the legs are “not responding” as expected. Patients often notice it is harder to walk in the dark when visual input cannot compensate for the cord dysfunction. Falls become more frequent.
Lhermitte’s Sign
A brief but unmistakable electric shock sensation that shoots down the spine and into the arms or legs when the neck is bent forward. This sign is pathognomonic of spinal cord compression and should trigger immediate MRI evaluation. Not every myelopathy patient has it — but those who do should not ignore it.
Arm or Leg Weakness
Progressive weakness in the arms, hands, legs, or all four limbs. Difficulty lifting objects, climbing stairs, or rising from a chair. Weakness from myelopathy tends to be bilateral and diffuse rather than the focal, one-sided weakness pattern of radiculopathy. Hyperreflexia (brisk reflexes) on examination is a common finding.
Neck Pain & Stiffness
Deep cervical pain and restricted range of motion. Importantly, many patients with significant myelopathy have surprisingly little neck pain — the cord can be severely compressed without prominent local symptoms. The absence of neck pain does not rule out myelopathy; the arm and gait symptoms are more reliable indicators.
Bladder & Bowel Dysfunction
Urinary urgency, frequency, difficulty initiating urination, or in severe cases incontinence. Bowel dysfunction is less common but can occur with severe cord compromise. Any new bladder or bowel changes in a patient with neck or arm symptoms warrants urgent evaluation — this represents a more advanced degree of cord injury.
⚠ Seek urgent or emergency evaluation
Most myelopathy develops slowly. These presentations require immediate attention:
- Rapidly progressive weakness in the arms or legs over days — acute myelopathy progression, may require urgent surgical decompression
- New bowel or bladder incontinence — severe cord compromise, do not wait for a scheduled appointment
- Sudden inability to walk or severe balance loss — may indicate acute cord compression or vascular event, go to emergency room
- Weakness in all four limbs simultaneously — high cervical cord compression, neurosurgical emergency
For any of these, go to the nearest emergency room or call 911 immediately.
How severe is your myelopathy?
Mild, moderate, or severe —
the grade shapes the urgency
Cervical myelopathy is graded by severity using validated clinical scales such as the modified Japanese Orthopaedic Association (mJOA) score and the Nurick grade. The grade helps determine timing of surgery and the expected benefit from decompression.
Mild hand clumsiness, mild gait change, no significant weakness. Patient is functional and independent. MRI shows cord compression without or with early T2 signal change. Surgical timing is a shared decision — some mild myelopathy patients can be monitored closely, others choose early decompression to prevent progression. Dr. Katsevman discusses this decision carefully with each patient.
Clear hand weakness or coordination loss, noticeable gait instability, some restriction in daily activities. MRI typically shows cord compression with T2 signal change. Surgery is generally recommended at this stage — the evidence shows better functional recovery when decompression occurs before deficits become severe. Waiting risks further cord injury.
Major weakness, inability to walk independently or safely, bladder dysfunction, severe hand impairment. MRI shows significant cord compression with established T2 signal change (cord injury signal). Surgery is urgent — the primary goal shifts from functional improvement to stopping further loss. Recovery is less complete than if surgery had occurred earlier.
What causes myelopathy
Why the cord gets compressed
Cervical myelopathy is most commonly caused by the cumulative degenerative changes of cervical spondylosis — but several specific pathologies can cause or worsen it.
Cervical Disc Herniation
A herniated cervical disc can compress the spinal cord directly, particularly a large central herniation at the midline. Soft disc herniations causing myelopathy are among the most urgently treated — the compression is often relievable with ACDF or disc replacement, and the cord has the best chance of recovery when decompressed promptly.
Cervical Spondylosis
The most common cause overall — the cumulative effect of disc degeneration, bone spur formation, facet hypertrophy, and ligament thickening narrowing the canal from multiple directions simultaneously. Develops slowly over years; symptoms typically begin in the 50s to 70s. Often involves multiple levels.
Ossification of the Posterior Longitudinal Ligament (OPLL)
Calcification of the ligament running along the back of the vertebral bodies directly into the spinal canal. More common in patients of East Asian descent. OPLL can cause severe myelopathy and requires careful surgical planning — the approach and technique depend on the extent and morphology of the ossification.
Ligamentum Flavum Hypertrophy
Thickening and buckling of the posterior canal ligament compresses the cord from behind, particularly with neck extension. Often contributes to cord compression in combination with anterior disc and bone spur pathology — the cord is caught between anterior and posterior compressors simultaneously.
Congenital Cervical Stenosis
A naturally narrow cervical canal from birth. These patients may develop significant myelopathy from relatively modest degenerative changes that would not affect someone with a wider native canal. They often present with myelopathy at a younger age and may have more severe cord compression for the degree of spondylosis on imaging.
Cervical Instability & Deformity
Abnormal motion between vertebrae (instability) or kyphotic (forward-bent) cervical alignment can cause dynamic cord compression — the cord is compressed or stretched with normal neck movement rather than in a fixed static position. Surgical approach must address both the decompression and the alignment or instability driving the dynamic compression.
Treatment approach
Conservative care vs. surgery
The decision between observation, conservative management, and surgery depends on myelopathy severity, rate of progression, MRI findings, and patient goals. Dr. Katsevman reviews each factor carefully before making a recommendation.
Observation & conservative care
For truly mild myelopathy with stable symptoms and no progression, careful observation with serial clinical and MRI monitoring is a reasonable option in selected patients. Physical therapy focused on cervical stabilization and avoiding provocative positions can help manage symptoms.
This is not watchful neglect. Patients managed conservatively require regular neurological follow-up. Any sign of progression — worsening hand function, gait, or new MRI cord signal change — shifts the recommendation toward surgery. Conservative management is not appropriate for moderate or severe myelopathy, or for patients with rapid progression at any severity.
Surgery — decompressing the cord
Surgery is the only treatment that reliably halts myelopathy progression and gives the cord the best opportunity to recover. The goal is to remove the structures compressing the cord and restore the canal space it needs. The approach is determined by the location, pattern, and extent of compression — not by surgeon preference alone.
Dr. Katsevman uses intraoperative neuromonitoring on every cervical case — continuous real-time tracking of spinal cord signals throughout surgery. Any change triggers an immediate alert. This is non-negotiable when operating adjacent to the spinal cord.
The four approaches
Every surgical option available —
one surgeon who performs them all
Most cervical spine surgeons in Southwest Florida offer ACDF and possibly disc replacement. Dr. Katsevman performs all four approaches — ensuring each patient receives the right operation for their anatomy, not the only operation their surgeon knows how to perform.
Anterior Cervical Discectomy and Fusion approaches from the front of the neck through a lipstick-sized incision — no muscles cut. The compressive disc and bone spurs are removed under microscope magnification, decompressing the cord from the anterior direction where most cervical stenosis originates. An interbody cage restores disc height and is stabilized with an anterior plate.
ACDF is highly effective for anterior cord compression at one to three levels. Dr. Katsevman’s refinements: neuromonitoring every case, prevertebral steroid injection to minimize swallowing difficulty, level-by-level technique for multi-level cases, and Corus® posterior facet cages for 360° stability in patients at risk for pseudoarthrosis.
For patients with mild myelopathy caused by a soft disc herniation without significant bone spur formation or instability, cervical disc replacement (ACDA) can decompress the cord while preserving motion at the treated level. Same anterior approach as ACDF, same-day discharge, but an artificial disc rather than a cage and plate.
Important distinction: Disc replacement is less appropriate for moderate-to-severe myelopathy with significant bone spurs or multi-level spondylotic stenosis, where the compressive anatomy is bony rather than a soft disc and motion preservation is less critical. Dr. Katsevman is on the surgeon locator for Simplify® and ProDisc-C®.
Performed from the back of the neck, laminectomy removes the posterior bony arch (lamina) over the affected levels, directly expanding the canal and allowing the cord to drift posteriorly away from anterior compressors. Particularly well-suited for multi-level myelopathy (3+ levels) and for cases where posterior element hypertrophy contributes significantly to the compression.
With fusion: When cervical alignment is kyphotic or when instability is present, laminectomy is combined with posterior instrumented fusion using lateral mass screws and rods to maintain alignment and prevent post-laminectomy kyphosis. Without fusion: In patients with maintained lordosis and a stable spine, laminectomy alone can achieve decompression without the additional surgery of fusion.
Laminoplasty hinges the laminae open and props them with small titanium plates, creating a larger canal while preserving the posterior bony arch. Unlike laminectomy, the laminae remain in place — expanded. Unlike ACDF, no fusion is required and some motion is maintained.
Ideal for: Multi-level cervical myelopathy in patients with maintained cervical lordosis who are not suited to a multi-level ACDF. It avoids the risks of extensive anterior multi-level surgery while providing reliable canal expansion. Not appropriate for patients with cervical kyphosis, where the cord would remain draped against anterior osteophytes despite posterior expansion — or where anterior compression is the dominant pathology.
Not all cervical spine surgeons perform laminoplasty. Dr. Katsevman does, ensuring every patient is evaluated for the full range of options.
Learn more
From Dr. Katsevman’s blog
Patient guides on cervical myelopathy, surgical options, and when to act.
Common questions
What patients ask most
Can cervical myelopathy get better on its own without surgery? +
Rarely, and not reliably. Unlike radiculopathy, which often improves as disc herniations resorb, cervical myelopathy is caused by structural narrowing of the spinal canal that does not resolve spontaneously. The natural history of untreated myelopathy is typically one of stepwise deterioration — periods of stability punctuated by acute worsening events. Some patients remain stable for months to years; others decline rapidly. The critical issue is that the cord cannot recover what it has already lost, so even periods of apparent stability represent ongoing risk if the compression remains. For mild myelopathy, careful monitoring with a clear plan for surgical timing is appropriate. For moderate or severe myelopathy, or any rapid progression, surgery is recommended.
Will I get better after surgery for myelopathy? +
Most patients improve after surgical decompression for myelopathy — but the degree of recovery depends heavily on how much cord injury existed before surgery. The clinical principle is: surgery stops further loss and gives the cord the best environment to recover, but cannot reverse established cord damage. Patients with mild myelopathy and no MRI cord signal change often see significant improvement. Patients with moderate myelopathy and early T2 signal change on MRI typically see meaningful but incomplete recovery. Patients with severe longstanding myelopathy and established cord injury may stabilize but see less functional improvement. This is why timing matters so much — earlier surgery, before cord injury is established, leads to better outcomes.
How do I know if my hand weakness is myelopathy or carpal tunnel? +
This is one of the most common diagnostic confusions in cervical myelopathy. Carpal tunnel syndrome causes hand numbness and weakness, typically worse at night, affecting the thumb, index, middle, and part of the ring finger. Myelopathy causes hand clumsiness and coordination loss — often without the classic nighttime numbness pattern — and is accompanied by gait instability, balance problems, or Lhermitte’s sign that carpal tunnel never causes. The key distinguishing features of myelopathy are bilateral symptoms, gait or balance changes, hyperreflexia on examination, and Lhermitte’s sign. A cervical MRI and a neurological examination will distinguish the two. Many patients have both conditions simultaneously, which is why treatment of carpal tunnel alone often provides incomplete relief when myelopathy is the primary driver.
Which surgery is right for my myelopathy — ACDF, disc replacement, laminectomy, or laminoplasty? +
The right approach depends on the location, extent, and pattern of cord compression; the number of levels involved; cervical alignment; the nature of the compressive pathology (soft disc vs. bony spurs); and patient anatomy. ACDF is the most versatile and is preferred for anterior compression at one to three levels. Disc replacement is an option for mild myelopathy from a soft herniation without significant bony stenosis. Posterior laminectomy (with or without fusion) is preferred for multi-level compression or when posterior elements are the primary compressors. Laminoplasty is preferred for multi-level myelopathy in patients with maintained lordosis who want to avoid both multi-level ACDF and fusion. Dr. Katsevman will review your MRI and clinical findings and explain which approach is most appropriate for your specific anatomy — and why.
I have been told to watch and wait with my myelopathy. Should I get a second opinion? +
Yes — particularly if you have moderate symptoms, progressive decline, or MRI findings showing cord signal change. Watch and wait is a reasonable strategy for truly mild, stable myelopathy under close surveillance. But it is not appropriate for moderate or severe myelopathy, any rapid progression, or established cord signal change on MRI. A second opinion from a surgeon who performs all four cervical approaches — and who is familiar with the evidence on surgical timing — will either confirm that observation is safe in your case, or identify that the window for optimal recovery is narrowing. Dr. Katsevman offers in-person and telemedicine second opinions for patients across Florida and nationally.
"I never tell a myelopathy patient to just wait and see. We watch carefully, we set thresholds, and we act before the cord pays the price of delay. That is the job."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Performs all four cervical decompression approaches: ACDF, cervical disc replacement, posterior laminectomy ± fusion, and laminoplasty
Neuromonitoring on every cervical case — real-time spinal cord safety monitoring, non-negotiable
Fellowship-trained at Barrow Neurological Institute — one of the world’s leading neurosurgical centers
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
30+ peer-reviewed publications in spine surgery and neurosurgery
Surgeon locator: Simplify® Cervical Disc (Globus Medical) & ProDisc-C® (Centinel Spine)
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google · Healthgrades Choice · WebMD Preferred · U.S. News Patients’ Top Choice
Offices in Naples & Fort Myers · Telemedicine second opinions available nationwide
Take the next step
Hand weakness. Balance loss.
The cord cannot recover what it loses.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or by telemedicine from anywhere. Bring your MRI. Get a clear answer on your diagnosis, severity, and the right surgical approach for your anatomy.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationally