Chapter 14 - Decision-making in the surgical management of degenerative cervical myelopathy

Abstract

Degenerative cervical myelopathy (DCM) results from degenerative cervical spondylosis that results in spinal cord compression, injury, and dysfunction. DCM is one of the most common indications for cervical spine surgery in the United States (US). Over 112,400 cervical spine operations for degenerative spondylosis are performed annually in the US with hospital charges now exceeding 2 billion dollars per year for these surgeries. Nearly 20% of cervical spine operations in the US are performed to treat cervical spondylotic myelopathy (CSM). Surgical decompression of the spinal cord and fusion of the spinal column can arrest the progression of this pathological condition and can sometimes permit recovery of spinal cord function. Many patients with mild CSM symptoms are treated expectantly. Numerous reports suggest that CSM surgery has a high complication rate (13.4%–17%). Moreover, there may be appreciable differences in the morbidity between different surgical approaches (e.g., anterior versus posterior) for DCM. For example, some specific complications (e.g., swallowing difficulty) have a greater incidence in anterior procedures compared with posterior procedures. For these and other historical reasons, there is uncertainty as to the optimal surgical approach (anterior versus posterior) for treating DCM. This is particularly true in older patients. Both operative approaches are in widespread use in contemporary US surgical practice. Moreover, laminoplasty (a motion-preserving type of posterior approach) is gaining importance as an effective surgical approach for many patients with DCM.