Surgical management of cervical myelopathy: indications and techniques for laminectomy and fusion.
BACKGROUND: Cervical spondylotic myelopathy (CSM) is a commonly encountered surgical disease that may be approached through a variety of operative techniques. Operative goals in the treatment of CSM include effective neural element decompression and maintaining spinal stability to avoid delayed deformity progression and neurologic compromise. Determining the most appropriate operative approach requires careful consideration of the patient's clinical presentation and radiographic imaging. PURPOSE: To review the indications and techniques for multilevel laminectomy and fusion in the treatment of CSM. CONCLUSIONS: When indications permit, a multilevel laminectomy is an effective and safe method of neural element decompression. Recognizing the potential for spinal instability is essential to prevent neurologic compromise and intractable axial neck pain caused by deformity progression. A variety of techniques have been described to supplement the posterior tension band after laminectomy; however, lateral mass fixation has evolved into the preferred stabilization technique. Although clinical success is well documented, a successful outcome is dependent on a comprehensive, individualized evaluation of each patient presenting with CSM.