Posterior decompressive procedures for the cervical spine

Cervical degenerative disease encompasses a complex array of pathologies. Before considering surgical intervention, the surgeon should have a complete understanding of the indications for surgery and should have conducted a thorough physical examination and evaluation of radiologic studies. In general, unless myelopathy is present, surgery should be the treatment of last resort, used only after conservative measures have failed. The indications for posterior cervical decompression include both radiculopathy and myelopathy. However, these conditions alone are not sufficient to indicate that a posterior procedure is appropriate. Other factors, such as bilaterality of symptoms, presence or absence of cervical lordosis, number of levels involved, and presence of axial neck pain, should also be considered when deciding whether an anterior procedure or posterior decompression is more appropriate.