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Posterior Surgical Treatment of Cervical Spondylotic Myelopathy

Review Article

  • CERVICAL SPINE SYMPOSIUM
  • Published:
HSS Journal ®

Abstract

Background

Cervical spondylosis is now recognised as the leading cause of myelopathy and spinal cord dysfunction worldwide. Chronic spinal cord compression results in chronic inflammation, cellular apoptosis, and microvacular insufficiency, which are thought to the biologic basis for cervical spondylotic myelopathy (CSM).

Questions/Purposes

Our purpose was to address the key principles of CSM, including natural history and presentation, pathogenesis, optimal surgical approach, results and complication rates of posterior surgical approaches for CSM so that the rationale for addressing CSM by a posterior approach can be fully understood.

Methods

We conducted a systematic search of PubMed/MEDLINE and the Cochrane Collaboration Library for literature published through February 2014 to identify articles that evaluated CSM and its management. Reasons for exclusion included patients with ossification of the posterior longitudinal ligament (OPLL), patients with degenerative disc disease without CSM, and patients with spine tumor, trauma and infection. Meeting abstracts/proceedings, white articles and editorials were additionally excluded.

Results

The search strategy yielded 1,292 articles, which was reduced to 52 articles, after our exclusion criteria were introduced. CSM is considered to be a surgical disorder due to its progressive nature. There is currently no consensus in the literature whether multilevel spondylotic compression is best treated via an anterior or posterior surgical approach.

Conclusion

Multilevel CSM may be safely and effectively treated using a posterior approach, either by laminoplasty or with a laminectomy and fusion technique.

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Disclosures

Conflict of Interest

Paul D. Kiely, MD, John C. Quinn, MD and Jerry Y. Du, BS, have declared that they have no conflict of interest. Darren R. Lebl, MD reports consulting fees from Medtronic; outside the submitted work; reviewer for The Spine Journal, Global Spine Journal, Journal of Spinal Disorders & Techniques, HSS Journal; Clinical Advisor - Spine Frontier.

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This article does not contain any studies with human or animal subjects performed by the any of the authors.

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Authors and Affiliations

  1. Spine & Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Paul D. Kiely MD, John C. Quinn MD, Jerry Y. Du BS & Darren R. Lebl MD

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Kiely, P.D., Quinn, J.C., Du, J.Y. et al. Posterior Surgical Treatment of Cervical Spondylotic Myelopathy. HSS Jrnl 11, 36–42 (2015). https://doi.org/10.1007/s11420-014-9425-5

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  • DOI: https://doi.org/10.1007/s11420-014-9425-5

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