Both conservative (non-surgical) and surgical approaches are available to treat cervical spondylotic myelopathy.
Conservative (non-surgical) treatment is aimed at decreasing pain by reducing spinal cord and nerve root inflammation, as well as improving the patient's function and ability to perform daily activities.
Treatment generally consists of a combination of temporary immobilization of the neck, steroidal and/or non-steroidal anti-inflammatory medications (such as COX-2 inhibitors or ibuprofen), as well as physical therapy.
Depending on the specific MRI/CT myelogram findings, other potential treatment options include various forms of cervical traction and epidural steroid injections.
Patients with overt spinal cord compression resulting in spinal cord dysfunction (myelopathy) may be referred directly for consideration of surgery. Two common indications for having surgery include:
- Symptoms failing to improve after 4 to 6 weeks of non-surgical management
- Progression of the symptoms in spite of non-surgical treatment
In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to decompress (relieve pressure on) the spinal cord has been the procedure of choice.
However, as previously described, 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 cervical laminectomy, with a clear subset of patients either failing to benefit or even getting worse after a laminectomy. Therefore, depending on the patient's anatomy, many surgeons prefer anterior decompression of the spinal cord and nerve roots (in the front of the spine).
These procedures are referred to as anterior cervical decompression and fusion operations. The surgeon may also use instrumentation (plates and screws) to provide immediate internal support for the cervical spine, and to promote bone graft healing.