Optimizing Surgical Cord Decompression in Traumatic Spinal Cord Injury and Degenerative Cervical Myelopathy

Preoperative assessment of intramedullary lesion length has become part of a planning algorithm for decompression surgery. In degenerative cervical myelopathy, intramedullary signal abnormalities on MRI often reflect ongoing biological activity rather than fixed tissue loss. As compression persists, reduced perfusion and altered cerebrospinal fluid dynamics may create a compartment-like intradural environment in which the spinal cord has limited reserve capacity. The goal of surgery remains restoration of a permissive intradural environment for the spinal cord. Intraoperative adjuncts such as ultrasonography or assessment of dural pulsatility may help verify adequacy of decompression.