Cervical spinal stenosis surgery [Neurosurgery Wiki]

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====== Cervical spinal stenosis surgery ======

Posterior approaches

a) [[cervical laminectomy]]: not typically used for a herniated cervical disc, more common for cervical
spinal stenosis, [[OPLL]]
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After ventral decompression of monosegmental cervical spondylotic stenosis, a [[stand-alone cage]] (SC) or [[cage]]-with-[[plate]] (CP) can be inserted for [[fusion]]. Postoperative radiological evaluation can be achieved using different imaging modalities.
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Coincident symptomatic [[lumbar spinal stenosis]] and [[cervical spinal stenosis]] is usually managed by first decompressing
the [[cervical region]], and later operating on the [[lumbar region]] (unless severe [[neurogenic claudication]]).
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Mild [[myelopathy]] ([[mJOA]] score > 12): in the short-term (3 years) patients may be offered the option of surgical decompression or nonoperative management (prolonged immobilization in a rigid cervical collar, anti-inflammatory medications, and “low-risk” activities or bed rest (Level C Class II)). patients with mJOA scores > 12 may not always be mildly impaired, they may derive significant improvement from surgery, and deterioration from this point may be ominous.

More severe myelopathy: should be treated with surgical decompression with benefits maintained at 5 and 15 years post-op (Level D Class III)

Level B Class I

Degenerative cervical radiculopathy: patients do better with anterior decompression ± fusion (compared to conservative management) for

● rapid relief (within 3–4 months) of arm & neck pain and sensory loss

● relief of longer-term (≥ 12 months) symptoms of weakness of wrist extension, elbow extension,
shoulder abduction, and internal rotation.

===== Intraoperative electrophysiologic monitoring =====

Use of intra-op [[electrophysiologic monitoring]] during routine surgery for CSM or [[cervical radiculopathy]] is not recommended as an indication to alter the surgical plan or administer [[steroid]]s since this paradigm has not been observed to reduce the incidence of neurologic injury (Level D Class III).

===== Outcome =====
Results suggest no significant improvement in overall erectile function postoperatively for patients with preoperative [[erectile dysfunction]]. This is important to address during patient counseling for [[decompression]] surgery candidates with [[cervical spinal stenosis]] and/or [[lumbar canal stenosis]] to manage expectations.
((Wottrich S, Kha S, Thompson N, Bakar D, Yee P, Melillo A, Nash C, Healy AT, Steinmetz M, Mroz T. The Effect of Cervical and Lumbar [[Decompression]] Surgery for [[Spinal Stenosis]] on [[Erectile Dysfunction]]. Global Spine J. 2022 Oct 25:21925682221136493. doi: 10.1177/21925682221136493. Epub ahead of print. PMID: 36281560.))