Surgical Approaches for Cervical Myelopathy

Anterior Surgical Approaches

The American Association of Neurological Surgeons recommends anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) for multilevel anterior cervical spine decompression for lesions at the disc level 1, 2, 3
ACDF is recommended for compression at disc levels, especially for short segment decompression, and involves removal of intervertebral discs and fusion of adjacent vertebrae 1, 3, 4
Anterior plating is recommended to provide stability and improve fusion rates in ACDF 4
ACCF is a recommended alternative to ACDF for multilevel anterior decompression and involves removal of vertebral bodies in addition to discs 1, 3, 4

Laminoplasty is comparable to anterior approaches for multilevel compression and preserves posterior elements while expanding the spinal canal 1, 3
Laminectomy with arthrodesis (fusion) is comparable to anterior approaches for improvement in cervical spondylotic myelopathy (CSM) and helps prevent late deformity associated with laminectomy alone 1, 3, 5

Factors favoring anterior approach (ACDF/ACCF) include compression primarily at disc levels, 1-3 level disease, and presence of kyphotic deformity 4, 5
Factors favoring posterior approach (laminoplasty/laminectomy with fusion) include multilevel disease (≥4 levels) and preserved or lordotic cervical alignment 5

Standalone laminectomy should be avoided due to risk of late deterioration and kyphotic deformity 1, 2, 3
Surgical treatment is recommended over conservative management for moderate to severe myelopathy 6

All surgical approaches provide near-term functional improvement for CSM 1, 2
Benefits of surgical decompression can be maintained for at least 5 years and up to 15 years postoperatively 6