The surgical approach is tailored to each patient. Anterior: ACDF or corpectomy for one to two level anterior compression. Posterior: laminectomy with fusion or laminoplasty for multi-level (three or more levels) posterior compression with maintained lordosis. Combined: anterior and posterior surgery for severe multi-level disease, kyphotic deformity, or OPLL. Each approach is described in its respective ConsentIQ leaflet — this overview helps patients understand how the decision is made.
Surgery is recommended for progressive cervical myelopathy — spinal cord compression causing hand clumsiness, gait imbalance, leg stiffness, and bladder dysfunction. Myelopathy tends to progress in a stepwise fashion and rarely improves without surgical decompression.
Observation with serial examination for very mild, stable myelopathy. Physiotherapy for balance and proprioception. Cervical collar for comfort. However, progressive myelopathy generally requires surgery — the spinal cord does not recover well from prolonged compression.
MRI showing cord compression. CT for bony anatomy and surgical planning. Myelopathy assessment scores (mJOA, Nurick). Assessment of cervical alignment (lordosis vs kyphosis) guides the surgical approach.
Prevention of neurological deterioration. Approximately 60–80% of patients stabilise or improve. Earlier surgery (before severe cord damage) gives better outcomes. The goal is to decompress the cord before irreversible damage occurs.
Neck stiffnessExpected
Expected after fusion, particularly multi-level.
Axial neck painCommon
Posterior approaches cause more post-operative neck pain.
Incomplete recoveryCommon
Long-standing cord compression may not fully recover.
C5 palsyUncommon
Weakness of deltoid after decompression. Usually recovers.
Spinal cord injuryRare
Risk approximately 1–2%. The compressed cord is vulnerable during surgery.
DysphagiaCommon
Swallowing difficulty with anterior approaches. Usually temporary.
Adjacent segment diseaseLong-term
New degeneration above or below the fusion.
CSF leakUncommon
Dural tear.
InfectionUncommon
Wound or deep infection.
Hardware failureUncommon
Screw loosening, cage subsidence, rod breakage.
General anaesthesia with neuromonitoring (SSEPs and MEPs). Careful intubation technique to avoid neck extension.
Hospital two to five days. Collar for four to twelve weeks depending on procedure. Balance and gait rehabilitation. Hand dexterity exercises. Return to desk work at four to eight weeks. Full recovery three to twelve months. Neurological recovery continues for up to eighteen months.
Reviews at two weeks, six weeks, three months, six months, and one year. X-rays and/or CT. Neurological assessment at each visit.
How is the surgical approach chosen?
The decision depends on the number of levels compressed, whether compression is mainly from the front or back, cervical alignment (lordosis or kyphosis), and patient factors. Anterior approaches are preferred for one to two level anterior compression. Posterior approaches are preferred for multi-level disease with maintained lordosis.
Will my hand function improve?
Many patients experience improvement in hand dexterity, though recovery depends on the duration and severity of compression. Earlier surgery gives better results. Some patients have permanent residual dysfunction if the cord was severely compressed for a prolonged period.