What is Cervical Spondylotic Myelopathy?

Cervical spondylotic myelopathy is a condition of the cervical spine, or neck, that occurs when the spinal cord is compressed due to normal wear and tear on the cervical spine over time. This injury is typically seen in patients over age 50. Compression on the spinal nerve can cause a range of degenerative abnormalities in the cervical disc leading to a condition called spondylosis, or neck arthritis.

Although developing cervical spondylosis is common, further conditions such as radiculopathy, or nerve root irritation, and spinal cord dysfunction may arise. Radiculopathy and myelopathy (compression) symptoms may present neurologic deficits such as:

  • Pain
  • Numbness in extremities
  • Difficulty walking
  • Unusual challenges with fine motor coordination
  • Hand weakness
  • Lower extremity muscle spasms
  • Decreased coordination and strength in gross motor tasks
  • Bowel and urinary urgency and incontinence

The causes of cervical spondylotic myelopathy are due to degenerative changes such as a herniated cervical disc or bone spurs. In some cases, cervical spondylotic myelopathy may also arise in patients diagnosed with:

  • Rheumatoid arthritis
  • Spine trauma
  • Cervical injury affecting the ligaments and muscles that support the vertebrae

Who is a Candidate for Spinal Cord Decompression Surgery?

Dr. Braxton evaluates patients to determine if spinal cord decompression surgery is recommended. A period of non-surgical treatments is the first course of treatment. Pain relief, muscle relaxants and anti-inflammatory medications are typically used. In patients with neuropathic pain, anticonvulsants or antidepressant medications may be used. A cervical collar may be used on a limited basis for support and protection. If symptoms do not improve within six to twelve weeks, or if symptoms worsen, a patient may be candidates for spinal cord decompression surgery. Patients with progressive neurologic changes such as weakness, numbness, coordination and balance issues and severe pain may also be candidates. Dr. Braxton works closely with patients to provide a comprehensive evaluation and recommendation of spinal cord decompression surgery.

What Surgical Procedures are used for Cervical Spondylotic Myelopathy?

Dr. Braxton offers advanced surgical treatment options for patients diagnosed with cervical spondylotic myelopathy. Most commonly, Dr. Braxton uses either laminoplasty or laminectomy with a posterior fusion to treat cervical spondylotic myelopathy. A cervical laminectomy is used to mitigate pressure to the spinal cord or spinal nerve. The goal of this procedure is to widen the spinal canal. This is achieved by removing the entire lamina, or bony roof of the vertebrae. This creates the space necessary for the spinal nerve, and compression is relieved. Normal nerve function is restored, and patient symptoms are reduced. Often following the laminectomy, a posterior fusion is performed to add stability to the repaired area. The advantages of the posterior approach include limited loss of motion, more level access, and no bone graft complications.

A second corrective surgery used for cervical spondylotic myelopathy is the cervical laminoplasty. This procedure is used when adequate spinal cord space can be restored without complete removal of the lamina. The procedure is similar to the laminectomy except that access to the spinal nerve and the resulting decompression is coupled with the preservation of some of the lamina. Depending on the patient’s condition, Dr. Braxton offers either a laminectomy with posterior fusion, or a laminoplasty as either an inpatient or outpatient surgery. The complexity of the injury along with patient health and fitness are some considerations when deciding on the appropriate procedure. Dr. Braxton supports the patient throughout the process with the goal of returning the patient to their preferred activities and lifestyle as quickly as possible.

What is the Recovery Like After Spinal Decompression Surgery?

Patients with cervical spondylotic myelopathy who undergo a laminectomy with posterior fusion can expect a recovery that includes surgical site care, pain management and a gradual return to activity based on Dr. Braxton’s postoperative protocol. The complexity of the surgery will dictate the recovery process. The incision should be monitored for any changes in swelling, redness, temperature or reopening. Showering should be postponed for a couple of days and the incision should be kept dry for 5 – 7 days. The incision should be kept covered in plastic wrap when showering again. Patients may also need to take some time off work.

Time spent sitting should be minimized to 20-30 minutes at a time. Sleeping in any pain free position is allowed and the use of a supportive brace is recommended on a limited basis. It is important to avoid bending, twisting and lifting. A light walking program within the first week can gradually increase. It is recommended that the use of stairs should be limited to once a day for the first two weeks. Any strenuous activity must be delayed until recovery is established.

Physical therapy may be helpful to promote safe movement with daily activities such as getting in and out of bed, chairs, and getting dressed. Driving should be postponed for the first two weeks and then done gradually. Recovery from spinal decompression surgery using laminectomy and posterior fusion may require a longer recovery than other treatments and full bone healing is typically within 4 to 12 months.

Patients who undergo a laminoplasty surgery can expect a similar recovery. A neck collar may be used for several weeks. Physical therapy may be prescribed after the initial recovery period. Most patients report a significant increase in normal nerve function and a decrease in symptoms. This improvement continues from 6 – 18 months as the spine heals. Complete resolution of the condition of cervical spondylotic myelopathy is a common result.

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How Successful is Spinal Decompression Surgery?

Patients who undergo cervical spinal decompression surgery, depending on the patient’s condition, report a success rate greater than 75%. This includes a decrease in pain and neurologic symptoms brought on by myelopathy. The repair to the spine and spinal nerve ameliorates any further degeneration and normal function is restored.

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