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.
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Conflicts of interest
The surgical management of spondylotic myelopathy is in the field of our daily practice. Technical steps for surgery are now well established, as raised by the present study. Nevertheless, the modern literature does not conclude to a better benefit/risk ratio of anterior approaches, compared to posterior ones. Moreover, the need for systematic arthrodesis that is recommended by the authors in cases of posterior approaches is debatable since kyphotic deformities can be prevented by a better preservation of the muscular environment during surgery and early postoperative reinforcement. In most cases, spondylotic myelopathy is due to an extensive stenosis that spreads over than two levels and involves elderly people. In this aspect, we do believe that a majority of these patients deserve a quick, simple and safe posterior procedure rather than a more complex one, either anterior or combined approaches. The latter ones should be reserved for very selected cases of underlying pathological condition of the axial skeleton.
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König, S.A., Spetzger, U. Surgical management of cervical spondylotic myelopathy – indications for anterior, posterior or combined procedures for decompression and stabilisation. Acta Neurochir 156, 253–258 (2014). https://doi.org/10.1007/s00701-013-1955-y