Assessment of Surgical Techniques for Treating Cervical Spondylotic Myelopathy

Narrowing of the spinal canal by osteophytes, ossification of the posterior longitudinal
ligament, or bulging of a large central disk can compress the cervical spinal cord and
impinge the spinal nerve roots, resulting in neck pain and various degrees of neurological
symptoms and impairment.2 In severe cases, this can lead to stenosis of the cervical spine,
resulting in upper motor neuron symptoms in the lower extremity and lower motor neuron
symptoms in the upper extremity. When conservative measures such as traction, cervical
collar, and postural exercises fail to prevent neurologic progression, surgery may be
indicated.

A variety of surgical approaches and procedures are available, and the optimal choice of
treatment remains controversial. Surgical procedures designed to decompress the spinal cord
and, in some cases, stabilize the spine have been shown to be successful, but there is a
persistent percentage of patients who do not improve with surgical intervention.3
Additionally, the potential complications of surgery for CSM may depend on the various
methods of surgical management. Historically, cervical laminectomy, a posterior approach, had
been regarded as the standard surgical treatment of CSM. However, over the past 20 years, it
has been increasingly recognized that laminectomy without fusion is not appropriate for all
patients and may result in instability and deformity. Because of the instability caused by
laminectomies, alternate surgical approaches such as anterior approaches to the spine and
laminoplasty have been developed, and have gained increasing popularity over the years.3 A
range of factors must be considered when deciding which surgical technique to use. Surgeons
are often challenged with determining the most appropriate technique because there is limited
information about whether there is a difference between surgical procedures in terms of
clinical and radiographic outcomes, in postoperative complication rates and in functional and
quality of life outcomes. Methods of treatment include conservative and surgical management.
Among surgically managed patients, an anterior or posterior approach may be employed. Among
those managed posteriorly, laminoplasty or laminectomy with fusion are common surgical
techniques. With several standards of care available for this population, a better
understanding of the corresponding positive and negative outcomes with respect to clinical
and patient-centered outcomes is warranted.

Inclusion Criteria:

- Patients undergo surgery for symptomatic cervical spondylotic myelopathy with one or
or more of the following symptoms: Numb clumsy hands, impairment of gait, bilateral
arm parasthesia, L'Hermitte's phenomena

- and one or more of the following signs: corticospinal distribution motor deficits,
athropy of hand intrinsic muscles, hyperflexia, positive Hoffman sign, upgoing plantar
responses, lower limb spasticity, broad based unstable gait

Exclusion Criteria:

- Asymptomatic cervical spondylotic myelopathy

- previous surgery for CSM

- Active infection

- Neoplastic disease

- Rheumatoid arthritis

- Ankylosing spondylitis

- Trauma

- Concomitant lumbar stenosis

- Not referred for surgical consultation

- Participating in other trials or unlikely to attend follow-ups