Anterior cervical decompression and spine fusion for spondylotic myelopathy

Benefits of anterior decompression and spine fusion surgery

In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to decompress (relieve pressure on) the spinal cord had been the procedure of choice to treat spondylotic myelopathy resulting from cervical arthritis.

However, the majority of the abnormal anatomy producing spinal cord compression is located anteriorly to (in front of) the spinal cord itself. This is only indirectly addressed by a posterior cervical laminectomy. In fact, chronic spinal instability exacerbating the disease process may be caused by cervical laminectomy. In addition, a thick fibrous scar forms at the operative site in the postoperative period, at times replacing the bony compression and reproducing the original symptoms after an extended postoperative period.

For these reasons, many surgeons prefer either anterior decompression of the spinal cord and nerve roots, or an adaptation of laminectomy known as laminoplasty, depending on the patient's anatomy. Anterior cervical decompressions have two significant benefits:

1. Direct removal of the anterior source of spinal cord compression.

2. Stabilization of the spine by way of a fusion, eliminating motion and the development of further degenerative changes at the operated levels.

Results of the spine surgery

Overall, most surgical series point to a significant improvement for most patients who undergo an anterior cervical decompression and fusion (by either multiple discectomies or corpectomy) before irreversible spinal cord injury has occurred. At a minimum the operation can remove the source of spinal cord injury and arrest the progression of the disease. The prognosis is generally proportional to the severity of spinal cord compression, with more advanced cases having a poorer prognosis. Timely intervention may thus play a role in determining the patient’s final outcome.