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Table 2 Surgical procedures for cervical spondylotic myelopathy

From: Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

Procedure Indications Contraindications Complications
Discectomy [28] Radiculopathy; Myelopathy; Myelo-radiculopathy; Traumatic instability involving single or multiple levels Increased age
Posterior cord/canal pathology
Recurrent laryngeal nerve injury -0.07 to 24.2%; Dysphagia – 12.3%; Hoarseness – 4.9%; unilateral vocal cord impairment -1.4%; Neurological complications – 0.3%; Pseudoarthrosis -6.9%*
Laminectomy with fusion [29] Multi-level (> 3 segments), myelopathy Cervical kyphosis Cervical kyphosis -21%; Hypermobility; Spinal cord injury -3%; Nerve root injury -15%; Penetration of vertebral artery -5.8–6.7%
Circumferential decompression with fusion [30] Bicolumnar failure; Flexion-compression injury; Burst fracture; Poor bone quality; More stable construct; decreases use of halo; improved graft fusion Increased age Vertebral fracture and graft extrusion; Fixed plate failure warranting revision surgery – 13%; Posterior wound failure – 3%
Laminoplasty [32, 42] Multilevel spondylosis and OPLL Cervical kyphosis
Poor results with 1–2 level decompression
Loss of lordosis – 22–53%; Kyphosis – 2–4%; Loss of ROM; decrease 17–50% and >70% with fusion; Infection; Fracture of the "hinged" side can lead to spinal cord injury; Axial neck pain -6–60%; Nerve root palsy 1–3 days post-op, predominantly motor loss of C5 – 11% (6.8% at 2 year follow-up)
Corpectomy [31] Multi-level disease; Extends behind posterior vertebral body; Severe osteophytosis; VB deformity Increased age
Posterior canal/cord pathology
Recurrent laryngeal nerve injury; CSF leakage; Sympathetic ganglion injury; Perforation of esophagus – 0.25%; Dysphagia – 45%; Veterbal artery injury – 0.3%; Bone graft complication; pseudoarthrosis – 7% with single level fusion and 30% with 3 level fusion
  1. *rate increases with each segmental level added