Pathologic changes and timing of surgery in cremasteric cervical spondylosis There are many pathologic types of cervical spondylosis. Among them, cremasteric cervical spondylosis is more dangerous due to compression of the cremaster, and if not treated early and timely, it is prone to serious consequences, even complications such as paraplegia. Common clinical symptoms include: (1) Neck discomfort or neck pain. (2) Numbness and weakness of the limbs (especially the lower limbs) and stiffness. (3) Upper limb dysfunction mainly manifests as weakness and instability in gripping objects, or even dislodging; some manifest as fine motor impairment. (4) Sensory impairment: mostly begins in the upper or lower extremities. In addition to detailed history, physical examination may reveal physiological hyperreflexia, positive pathological reflexes, increased muscle tone, abnormal sensation, and hypotonia. Imaging examination is an important adjunct to the early diagnosis of the disease. Routine radiological examinations can provide bony spinal canal sagittal diameter and Pavlov’s ratio. MRI is valuable in evaluating the soft tissue (e.g., discs) and crestal medullary status. It can show the degree of crestal medullary compression and the extent of crestal medullary damage. Crestal cervical spondylosis itself has a certain natural history, and surgery may achieve the goal of stopping the deterioration of clinical symptoms, but if the damage to the crestal medulla has reached an irreversible stage, even if the compression is removed, it will not improve or restore the function of the crestal medulla. Thus, once the diagnosis of cremasteric cervical spondylosis is established, aggressive countermeasures should be taken. Non-surgical treatment time should be closely observed for signs and symptoms, and surgical treatment should be performed as soon as possible if there is an aggravation or signal change of crestal medullary damage on imaging, without waiting and watching. The timing of surgery for cremasteric cervical spondylosis depends on a combination of factors. Importantly, the natural history of each patient varies. Most patients have persistent motor dysfunction and worsening signs and symptoms with each episode, while some patients have slow progression of the lesion, resulting in neglect by the examiner and the patient. Most scholars advocate early surgical decompression to allow for recovery of the compressed cremaster. The timing of surgery is most appropriate before severe irreversible loss of neurological function may occur. Clinical observations suggest that surgery within 6 months of onset has the best outcome.