Surgical management of myelopathy.

We have presented a comparative analysis of the ability of four surgical procedures to address adequately the problems sustained by a patient with symptomatic cervical myelopathy. AIA is a safe procedure whose effectiveness may be limited when the extent of disease is more than three intervertebral disk levels. ACA permits more direct and extensive access to the spinal cord and is the procedure of choice for cervical spondylotic myelopathy associated with spinal deformity. However, rigid external immobilization is necessary, and operative morbidity may be greater. Cervical laminectomy may be effective for decompressing the spinal cord when no associated spinal deformity or instability is present, provided that extensive resection of facet joints is avoided. Cervical laminaplasty is ideally suited for the patient with three or more levels contributing to a cervical myeloradiculopathy. Mild instability may be addressed by performing arthrodesis on the hinge side.