Cervical spondylosis: natural history and rare indications for surgical decompression

Degenerative disc disease may be considered a normal process of aging which occurs in virtually the entire population that reaches middle age. Pain problems associated with it should be approached with the greatest reluctance by the surgeon since intermittent flare-ups with subsidence and ultimate overall improvement can be expected in most cases. The clearest indications for surgery have to do with neurologic deficit. The simplest and most obvious example is herniated nucleus pulposus with acute monoradicular or myelopathic symptoms. This situation requires an aggressive approach. More chronic neurologic changes must be approached more cautiously. When unequivocal progression is identified, surgical decompression is in order. Finally, narrowing of the canal from either congenital or acquired processes may in some instances justify prophylactic surgical decompression, but requires the greatest caution. The radiologic findings often do not correlate with the signs and symptoms. The patient's input and his or her full awareness of the possibilities of serious complication is an essential part of good surgical management.