Operative treatment of cervical spondylotic myelopathy

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.