Anterior Cervical Decompression and Fusion for Cervical Spondylosis with Myelopathy

Historically, cervical laminectomy to remove the posterior (in the back) aspects of the spinal canal to relieve pressure on the spinal cord had been the procedure of choice to treat spondylotic myelopathy resulting from cervical arthritis. (See Cervical Laminectomy for more information.)

However, the majority of the abnormal anatomy producing spinal cord compression is located anteriorly to (in front of) the spinal cord itself. This problem is only indirectly addressed by a posterior cervical laminectomy. In fact, chronic spinal instability caused by cervical laminectomy may in fact make the disease process worse. 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 decompression surgery has three significant benefits over laminectomy:

  1. Direct removal of the anterior source of spinal cord compression without manipulation of the spinal cord and roots.
  2. Stabilization of the spine by way of a fusion, eliminating motion and the development of further degenerative changes at the operated levels.
  3. Generally, less pain. The approach is done by dissecting along tissue planes, not cutting muscle as required by a posterior cervical approach.
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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); provided that the surgery is performed before irreversible spinal cord injury has occurred.1

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.

References:

  1. Mayr M, Subach B, et al, "Cervical spine stenosis: outcomes after anterior corpectomy, allograft reconstruction and instrumentation," Journal of Neurosurgery (Spine 1) 96:10-16, 2002.
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