Cervical Myelopathy: Indication and Operative Procedure

Abstract

The most common cause of spinal cord dysfunction is related to nontraumatic, noninfectious and nononcologic causes such as degenerative disc disease, hypertrophy of the ligamentum flavum, ossification of the posterior longitudinal ligament (OPLL) and progressive kyphosis. Cervical spinal cord dysfunction due to these pathologies is referred to as degenerative cervical myelopathy (DCM) leading to neurological deterioration and reduced quality of life. Treatment options for DCM range from non-surgical conservative approaches to surgical 360° reconstruction procedures of the cervical spine. Optimal treatment requires thorough knowledge of the natural history of the disease, detailed expertise in surgical decision making, experience in anterior and posterior approaches to the cervical spine as well as medical expertise related to intra- and postoperative management of patients with (chronic) spinal cord injury. The following chapter outlines three different cases of DCM focusing on timing of treatment and treatment indication (Case 1), surgical decision making (anterior vs. posterior vs. combined technique, Case 2) and the special pathology of ossification of posterior longitudinal ligament (OPLL, Case 3). Rationale for surgical treatment derived from typical symptomatology and preoperative imaging/diagnostics is demonstrated. Surgical techniques, approaches and risks are discussed in relation to the pathoanatomical presentation of DCM based on three exemplary cases.