JBJS | Operative Treatment of Cervical Spondylotic Myelopathy

The Journal of Bone & Joint Surgery, Volume 88, Issue 7

Current Concepts Review | July 01, 2006

Operative Treatment of Cervical Spondylotic Myelopathy

Raj D. Rao, MD¹; Krishnaj Gourab, MD¹; Kenny S. David, MD¹

¹ Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226

The Journal of Bone & Joint Surgery. 2006; 88:1619-1640 doi:10.2106/JBJS.F.00014

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Nonoperative treatment with collar immobilization and modification of activities improves functional status in selected patients with mild cervical spondylotic myelopathy. Careful monitoring of these patients is necessary as neurological deterioration can occur in spite of this treatment. Early operative management is beneficial for most patients with moderate or severe myelopathy. The primary aims of operative intervention for the treatment of cervical spondylotic myelopathy are decompression of the spinal cord and stabilization of levels at which excessive motion may be contributing to the myelopathy. Anterior operative approaches are preferred in patients with compression of the spinal cord at one, two, or three disc levels and those with loss of cervical lordosis. A higher rate of approach and graft-related complications generally favor a posterior approach when more than three levels are involved. Appropriate operative management results in satisfactory recovery from myelopathy in most cases, with improvement more likely in patients who have operative treatment earlier in the course of the disease and in those with less comorbidity.

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Topics

laminectomy ; spinal cord diseases ; decompression, external ; decompressive incision ; spinal cord ; cervical spondylotic myelopathy ; laminaplasty ; cervical diskectomy ; cervical myelopathy ; tissue transplants

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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