By Dale Segal, MD
There is a misconception that loss of balance is a normal part of aging. This is not true. While decreased strength and agility occurs with physiologic aging, progressive loss of balance can be a sign of a serious underlying health problem.
Loss of balance or gait instability is one of the most common symptoms of cervical myelopathy. Cervical myelopathy refers to damage to the spinal cord that is caused by neural compression or spinal stenosis. Cervical myelopathy is most commonly caused by age-related degenerative changes to the cushioning discs and supporting ligaments between the bones (i.e., vertebrae) of the cervical spine. These degenerative changes (alternatively referred to as “degenerative disc disease,”“spondylosis,” or “arthritis”) can create bulging discs, bone spurs, ligament thickening, and even unstable motion between the vertebrae, all of which may then lead to a narrowing of the space available for the spinal cord, otherwise known as “cervical stenosis.” Myelopathy occurs when the stenosis is significant enough to compromise normal spinal cord function.
Patients with cervical myelopathy commonly complain of unsteadiness when walking. Other common complaints are loss of hand dexterity; for example, difficulty buttoning shirts or opening jars and bottles. Cervical myelopathy is a common and frequently underdiagnosed medical condition which tends to occur in adults over 60 years of age. Cervical myelopathy can be difficult to diagnose because it is not always associated with neck and arm pain. In addition, early, milder stages of myelopathy can present with subtle loss of function that may mistakenly be attributed to “getting older,” when in fact it is due to spinal cord compression and resulting nerve damage.
While balance loss is one of the most common symptoms of cervical myelopathy, not all balance loss is caused by cervical myelopathy. Deconditioning and natural physiologic aging can result in loss of flexibility and agility. Having a fitness routine that includes core muscle strengthening is paramount to maintaining balance and healthy posture. Cardiovascular training and yoga are excellent for promoting balance health and well-being.
If loss of balance develops suddenly, is progressively worsening or is associated with loss of hand dexterity, neck pain, arm pain or hand numbness then it is important to seek evaluation from a spine specialist. An MRI will be ordered to ensure that there is no evidence of cervical myelopathy. If left untreated cervical myelopathy can cause permanent impairment. However, if cervical myelopathy is identified and treated in a timely manner, it can result in significant improvement in quality of life.
Dale Segal, MD
Dr. Segal is a fellowship-trained spine surgeon specializing in minimally invasive and complex spine surgery. He completed a spine fellowship at Harvard University- Massachusetts General Hospital and Brigham & Women’s Hospital. He grew up in New York and graduated Summa Cum Laude from the University of Albany with a degree in biochemistry and molecular biology. He was awarded the John T. MacDonald scholarship to attend Florida International University where he obtained his medical degree and graduated with Alpha Omega Alpha honors. He completed his residency at Emory University and served as chief resident at the Emory Orthopedics and Spine Hospital. As a dedicated spine surgeon, he devotes his practice to the diagnosis and treatment of spinal disorders. His interests include minimally invasive, motion sparing techniques, degenerative diseases, navigation and robotics, deformities, fractures, and complex revisions. He has authored numerous peer-reviewed journal articles, book chapters and presented at national and international conferences. He is a member of several spine and orthopedic societies including NASS, AAOS, AOA. In his spare time, he enjoys spending time with his family, watersports, scuba diving, and hiking.
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