Posterior surgical treatment of cervical spondylotic myelopathy: review article.
BACKGROUND
Cervical spondylosis is now recognised as the leading cause of myelopathy and spinal cord dysfunction worldwide. Chronic spinal cord compression results in chronic inflammation, cellular apoptosis, and microvacular insufficiency, which are thought to the biologic basis for cervical spondylotic myelopathy (CSM).


OBJECTIVE
Our purpose was to address the key principles of CSM, including natural history and presentation, pathogenesis, optimal surgical approach, results and complication rates of posterior surgical approaches for CSM so that the rationale for addressing CSM by a posterior approach can be fully understood.


METHODS
We conducted a systematic search of PubMed/MEDLINE and the Cochrane Collaboration Library for literature published through February 2014 to identify articles that evaluated CSM and its management. Reasons for exclusion included patients with ossification of the posterior longitudinal ligament (OPLL), patients with degenerative disc disease without CSM, and patients with spine tumor, trauma and infection. Meeting abstracts/proceedings, white articles and editorials were additionally excluded.


RESULTS
The search strategy yielded 1,292 articles, which was reduced to 52 articles, after our exclusion criteria were introduced. CSM is considered to be a surgical disorder due to its progressive nature. There is currently no consensus in the literature whether multilevel spondylotic compression is best treated via an anterior or posterior surgical approach.


CONCLUSIONS
Multilevel CSM may be safely and effectively treated using a posterior approach, either by laminoplasty or with a laminectomy and fusion technique.
Spine & Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Paul D
PD
Kiely
Spine & Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
John C
JC
Quinn
Spine & Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Jerry Y
JY
Du
Spine & Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Darren R
DR
Lebl
cervical spondylotic myelopathy; natural history; optimal management; pathogenesis; posterior surgical treatment options; presentation