Neurosurgical treatment of cervical spondylosis

  The root cause of cervical spondylosis is mostly spinal cord compression caused by degeneration of the intervertebral discs in the diseased segments, and the compression includes degenerative protrusion of the intervertebral discs, bone redundancy at the posterior edge of the vertebral body and thickening and calcification of the posterior longitudinal ligament and ligamentum flavum. Anterior cervical spine surgery is a surgical method designed to relieve the compression of the spinal cord and nerve roots from the anterior cervical discs or bony bulges.  Anterior surgery can directly remove the above pathological changes and pressure-causing factors, and slotting decompression can remove most of the protruding disc nucleus pulposus and the hyperplastic posterior border of the vertebral body and the medial part of the pedicle, and can remove the hypertrophic posterior longitudinal ligament, etc. The degeneration of cervical spondylosis is not usually narrowed throughout the spinal canal, but mostly within 3 vertebral bodies, so anterior surgery can generally achieve the purpose of decompression. Anterior cervical spine surgery is easy to expose, convenient to operate, and less bleeding, and familiar people can generally complete the exposure within 5-10 min. It can directly release the compressor and expand the spinal canal forward, while making bone graft fusion to stabilize the cervical spine and maintain the height of the cervical spine.  It has become a routine practice for neurosurgery to use a microscope in the treatment of cervical spine disorders through anterior decompression surgery. Because the microscope magnifies the surgical field more than 10 times and provides good coaxial light, anterior cervical spine surgery under the microscope can increase the degree of decompression to a higher level. The use of high-speed grinding drills in neurosurgery, which essentially eliminates the need for “hand tools” such as scrapers and biting forceps, also makes surgery much more efficient and safe.  The efficacy of anterior cervical spine surgery is determined by many factors, and accurate positioning, fine surgical technique, and the choice of indications are key. It is generally advocated that for cervical spondylosis caused by a single or two disc lesions, the excellent rate of anterior decompression surgery can reach 75%-95%, and the main purpose of the surgery is to decompress and rebuild the stability of the spine. It is generally believed that the timing of surgery is the primary issue that affects the efficacy, i.e., surgery before irreversible damage to the compressed vascular nerve tissue can achieve the best therapeutic effect.