Surgical management of cervical spondylotic myelopathy - indications for anterior, posterior or combined procedures for decompression and stabilisation

The authors describe their experience with the choice of anterior, posterior and combined approaches for the surgical treatment of spondylotic myelopathy. Description of surgical anatomy, surgical technique, indications, limitations, complications, specific perioperative considerations and specific information to give to the patient about surgery and potential risks and a summary of 10 key points is given. If the disease extends behind the posterior vertebral body and if reestablishing spinal sagittal and coronal balance is an aim, then the anterior approach is the best choice. In cases of predominant posterior spinal cord compression and lordotic configuration the posterior approach should be preferred. Decompression of three or more levels, especially in combination with poor bone quality, requires a combined approach.