CERVICAL SPONDYLOTIC MYELOPATHY: SURGICAL TREATMENT OPTIONS
One of the most common neck conditions that occurs with age is cervical spondylotic myelopathy (CSM). Over time, the normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal. This compresses — or squeezes — the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, and weakness (AAOS, 2015).
Symptoms usually begin after the age of 50, but can occur earlier if there was an injury to the spine at a younger age. Many people with CSM will have steady progression of their disease. Once symptoms start, they tend to continue. Typically, the disease progresses slowly over several years. In about 5% to 20% of people, CSM worsens more rapidly.
We will consider many options regarding treatment for cervical myelopathy, including your overall health, and will discuss the advantages and disadvantages of surgical interventions.
People who have progressive neurologic changes (such as weakness, numbness, or falling) with signs of severe spinal cord compression or spinal cord swelling are candidates for surgery. Patients with severe or disabling pain may also be helped with surgery.
People who experience better surgical outcomes often have these characteristics:
- The symptom of an electrical sensation that runs down the back and into the limbs
- Younger age
- Shorter duration of symptoms
- Single rather than multiple areas of involvement
- Larger areas available for the cord
Patients with overt spinal cord compression resulting in spinal cord dysfunction (myelopathy) may be referred directly for consideration of surgery. Two common indications for having surgery include:
- Symptoms failing to improve after 4 to 6 weeks of non-surgical management
- Progression of the symptoms in spite of non-surgical treatment
In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to relieve pressure on the spinal cord has been the procedure of choice.
Depending on the patient’s anatomy, many surgeons prefer anterior decompression of the spinal cord and nerve roots (in the front of the spine).
These procedures are referred to as anterior cervical decompression and fusion operations. The surgeon may also use instrumentation (plates and screws) to provide immediate internal support for the cervical spine, and to promote bone graft healing.
There are many successful surgical techniques for treating CSM. The goal of surgery is to open the space for the spinal cord, or “decompress” the spinal canal. The decompression is performed either from the front of your neck (anterior) or the back (posterior). Each approach has its advantages and disadvantages and these should be discussed with your surgeon. Neither surgical approach is ideal for every patient.
- Anterior cervical discectomy and fusion
- Anterior cervical corpectomy and fusion
Each option comes with its own set of benefits and risks. Call today for a consultation with spine expert Hamid Mir M.D. (949) 988-7848.