In my experience, the recognition that disorders of the spinal cord can be associated with chronic pain has often been undervalued or underestimated. It’s become clear that a variety of different disorders that can cause spinal cord dysfunction are present in people who have ongoing pain. We typically think of spinal cord compression, the most common reason for such being cervical spondylosis or spondylotic arthritic degenerative changes that may occur over time. They may ultimately result in bony encroachment of the spinal cord either in the thoracic or cervical, more likely cervical region. We often overlook the non-structural reasons such as various vitamin deficiencies, metabolic disorders in general, and also various infections. There’s actually quite a long list of potential etiologies to myelopathies that result in ongoing pain, and clinicians should be aware of both structural and non-structural etiologies when evaluating that.
What is important is recognizing the presence of a spinal cord abnormality from the history and the old fashioned physical examination. Clinicians need to recognize the complaints and the physical examination findings that suggest a spinal cord abnormality or a myelopathy and pursue by referring to someone who can further assess. Raising the question before someone undergoes an invasive treatment can actually help in the long run.