Surgical Management of Cervical Myelopathy

Abstarct Although general consensus exists regarding the need for surgery in patients with cervical myelopathy, there remains considerable debate regarding the optimal approach. Common choices include anterior decompression and fusion, or posterior approaches such as laminoplasty, laminectomy, or laminectomy and fusion. Aside from laminectomy alone, which has proven to be less favorable than its alternatives for a number of reasons, the available literature suggests that any of the other options provide similar rates of neurologic recovery. However, anterior versus posterior approaches come associated with very different sets of pros and cons. Depending on a number of factors -such as host biology, host bone quality, kyphosis, coexisting axial neck pain symptoms, number of motion segments involved in the genesis of the cord compression, and the desire to either preserve or limit motion – either approach can yield satisfactory outcomes. In general, when cord compression arises from three or less motion segments and any associated kyphosis is mild to moderate, anterior surgery may be preferable. If it arises from three or more segments in the absence of significant kyphosis, laminoplasty may be preferable. If cord compression coexists with significant kyphosis or deformity, anterior and posterior surgery may be necessary. Regardless, the approach chosen must be tailored to the specifics of the individual patient so as to achieve adequate spinal cord decompression, which remains the sine qua non of surgery.