Cervical spinal stenosis surgery
Posterior approaches
a) cervical laminectomy: not typically used for a herniated cervical disc, more common for cervical spinal stenosis, OPLL
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.
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).
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 steroids 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. 1)