Surgical Treatment: Cervical Spondylotic Myelopathy with Cord Compression

Selected Treatment
There is no place for nonoperative treatment in these kinds of cases. The goals of the surgical treatment in this case, include spinal cord and brain stem decompression, realignment of bone, and maintenance of cervical alignment with osseous fusion.

Surgical intervention is mandatory in cases with significant cord compression, myelopathic presentation, severe pain, or progressive neurological deterioration. Ventral medullary cervical junction and upper cervical cord decompression may be obtained by direct transoral approach. Anterior stabilization of the atlanto-axial complex is possible, but may need to be augmented with a posterior fusion. In cases with multiple level diseases, like our case, we think the best treatment option is the posterior approach.

Procedure
Image-guided, 3-dimensional, computer-assisted frameless stereotactic navigation; suboccipital decompression; C1-C7 bilateral cervical laminectomies, undercutting T1.

Occipital-cervical reconstruction with Mountaineer titanium instrumentation using midline occipital screws fixation, C1 lateral mass screws fixation, C2 pars/ pedicle screws fixation, C3-C7 lateral mass screws fixation, and T1 pedicle screws fixation.

Bone grafting with autogenously local bone graft supplemented with one unit bone morphogenic protein.

Monitoring upper and lower limbs somatosensory evoked potentials and segmental EMG activity during surgery.