Surgical treatment of cervical myelopathy of unclear aetiology

In some cases neither the clinical pattern nor the findings of magnetic resonance imaging (MRI) can help to determine the cause of a cervical myelopathy. The differential diagnosis of such cases as a rule includes spondylotic myelopathy, a solitary focus of multiple sclerosis and an intramedullary tumour in early stage. Worsening of signs and symptoms due to the circumscribed lesion of the spinal cord can require surgical treatment, even if no certain diagnosis could be stated thus far. The question is how to choose a surgical procedure which is beneficial for all three kinds of spinal cord pathology in their initial stage, which at the same time does not jeopardise spine and spinal cord and allows secondary surgery if needed after the precise nature of the lesion has been assessed. Ventral decompression and fusion with or without dorsal decompression seems to be a convincing procedure.