Treatment options for cervical
spondylotic myelopathy
Both conservative (non-surgical) and surgical
approaches are available to treat cervical spondylotic
myelopathy.
Non-surgical treatment for 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
spine surgery. Failure of the patient to improve
after 4 to 6 weeks of conservative management
or progression of their symptoms in spite of
it, are other indications for surgical evaluation.
Spine surgery for cervical spondylotic myelopathy
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. These procedures
are referred to as anterior cervical decompression
and spine 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.
By: Thomas
M. Wascher, MD, FACS
August 31, 2001
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