[Surgical treatment in cervical spondylosis]

The most common cause for progressive cord and nerve root deterioration is cervical spondylosis. Symptoms often develop insidiously and are characterized by neck stiffness, arm pain, hand numbness, weakness in the hands and legs, gait disturbances--recognized in the clinical practice as cervical spondylotic myelopathy (CSM), cervical radiculopathy or both of them. The imaging diagnosis has to begin with plain radiographs of cervical spine, but magnetic resonance imaging (MRI) is a procedure of choice. Narrowing of the spinal canal caused by osteophytes, herniated disc, lig. flavum hypertrophy and myelomalacia are typical MRI signs. Eighty consecutive patients (46 men and 34 women) with documented CSM and/or radiculopathy have undergone surgery. The patients' age at surgery varied from 26 to 80 years (average 50 years). According to the predominant clinical symptoms 45 patients (34 men and 11 women) were with CSM, 35 patients (12 men and 23 women)--with radiculopathy. The clinical evaluation was obtained by the Nurick Scale. Seventy three patients (91%) underwent surgery via the anterior approach in different levels. The following surgical procedures were applied: discectomy and/or osteophytectomy followed by fusion with tricortical bone autograft or fibrocarbone cages, with or without anterior titan plate fixation. Decompressive laminectomy was performed in 7 (9%) patients. Postoperative functional outcome and follow up was achieved in 71 (89%) patients. In 64 (90%) of them was assessed progressive clinical improvement; without changes were 7 (10%) patients. No early or late complications, induced by surgical approach, bone grafts and implants were observed. Although the choice of surgical treatment in cervical spondylosis remains controversial, currently anterior decompression and fusion is appropriate for many cases. We are giving priority to the anterior approach on the basis of our current surgical results.