Cervical spondylosis is a common disease in the middle-aged and elderly population, and is a degenerative disease caused by degeneration of the cervical disc and its secondary changes stimulating or compressing the adjacent tissues, and causing various corresponding manifestations.
Briefly, since the degenerated tissues that compress the spinal cord and nerve roots may come from the front of the spinal cord, such as degenerated herniated discs, bone spurs at the posterior edge of the vertebral body, and ossified posterior longitudinal ligaments; or from the back of the spinal cord, such as thickened ligamentum flavum; or even because of the developmental spinal stenosis (i.e., congenital small cervical spinal canal cross-sectional area, which is more common in yellow Asians than in others), cervical spondylosis is Therefore, there is a difference between anterior (surgery from the front of the neck) and posterior (surgery at the back of the neck) surgery for cervical spondylosis.
I. Anterior cervical surgery (Figures 1 and 2)
It is divided into anterior cervical discectomy and intervertebral fusion, and anterior cervical subtotal dissection and intervertebral fusion.
intervertebral fusion.
The purpose of surgery is to decompress, stabilize, and correct the physiological curvature of the cervical spine from anterior, localized compression and stenosis.
2.Anterior cervical discectomy and interbody fusion: for spinal cord cervical spondylosis, neurogenic cervical spondylosis caused by disc or bone spur compression, or ossification of the posterior longitudinal ligament in a single segment.
Advantages: direct release of compression; restoration of the physiological curvature of the cervical spine.
Limitations: Not applicable to multi-segment and severe spinal cord compression.
3. Anterior cervical subtotal vertebral body resection and intervertebral fusion.
Advantages: Removal of intervertebral discs, vertebral spurs and other anterior compressive materials. The decompression is complete and extensive.
Limitations: continuous type of cervical posterior longitudinal ligament ossification, severely impaired spinal cord function, and combined developmental spinal stenosis have high surgical risk or poor results.
II. Posterior cervical surgery (Figures 3 and 4)
For multi-segmental cervical spondylosis with spinal stenosis or continuous posterior longitudinal ligament ossification.
Advantages: indirect decompression is achieved by decompressing and reconstructing the posterior cervical lamina. The surgical risk is less than that of the anterior approach, and the efficacy is definite.
Cervical limitations: Not indicated in patients with cervical kyphosis.
The spine surgeon needs to develop an individualized surgical approach based on each patient’s clinical presentation characteristics and imaging manifestations to achieve a satisfactory outcome.
Figures 1 and 2: MRI before anterior cervical surgery, postoperative X
Figure 3, 4.
Pre- and postoperative CT of posterior cervical approach