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Cervical Myelopathy Treatment Options

Patients with signs and symptoms of cervical myelopathy require evaluation by a spine surgeon with expertise in complex spine conditions such as Chicago spine surgeon, Dr. Kern Singh. In many instances, patients will be considered for urgent surgical intervention to relieve the pressure on the spinal cord. All surgical procedures are performed on the patient who is under general anesthetic.

The treatment of cervical myelopathy depends on the severity of symptoms and the underlying cause. In mild cases, a trial of conservative management may be recommended including:

  • Rest and activity modification
  • Physical therapy and exercises to improve neck strength and flexibility
  • NSAIDS for pain relief

However, when symptoms are severe, rapidly progressing or do not respond to conservative measures, Dr. Singh may recommend a surgical solution for myelopathy.

What are the surgical treatment options for cervical myelopathy?

The goal of surgery, regardless of the surgical method used, is to decompress the spinal cord by removing the cause of the pressure on the cord. The goal is to reduce the risk of neurologic deterioration over time, and to improve the current symptoms. The three most common surgeries for treating cervical spondylotic myelopathy include:

ACDF is widely employed to treat cervical myelopathy caused by herniated discs or bone spurs.

In an ACDF, Dr. Singh accesses the spine by making a small incision, about one inch long, at the front of the neck, gently pushes aside the muscles and soft tissues, and removes the herniated disc and any bone spurs. He then places a bone graft or plastic cage in its place. A bone graft helps to fuse the vertebrae above and below for stability. A metal plate may also be used for stability. Patients can typically leave the surgery center the same day or the next day. It typically takes about three to six months for the bone graft to take. Most patients do NOT need a cervical fusion and Dr. Singh offers several other motion preserving procedures in lieu of a cervical fusion which is the last resort.

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Artificial cervical disk replacement has become a viable surgical alternative to anterior cervical discectomy and fusion (ACDF) in almost all patients. In artificial cervical disc replacement, the damaged cervical disc is removed and replaced with an artificial disk made up of titanium and plastic (like a total knee or hip replacement). Compared to a cervical fusion, which involves plates and screws, disc replacement maintains motion leading to less wear and tear on the vertebra above and below the surgery site. Patients are discharged the same day without the need for a neck collar.

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Microsurgical cervical laminoplasty is a minimally invasive technique for decompression of cervical nerves from the back of the neck. By using operating microscopes in spinal surgery, Dr. Singh works through a smaller incision and with greater safety because of the surgeon’s visualization of spine and nerve tissue during spinal surgery.

First, Dr. Singh will make a small incision on the back of the neck to expose the affected cerebral vertebrae. Then using a specialized microscope and instruments, he gently moves aside the muscles along the back of the neck in order to access the affected vertebrae. Next, Dr. Singh carefully opens a portion of the lamina preserving the small, attached muscles around it to gain access to the nerves that travel within the spinal canal. Then, he can use the specialized instruments to remove the cause of the compression, including bony spurs, and any other structures that are compressing the cord and nerves. He keeps the lamina (bone open) using ultra tiny surgical plates that he has designed for surgeons to use all over the world.

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The choice of surgical procedure depends on factors such as the severity of symptoms, the underlying cause, and the patient’s overall health.

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When you or a loved one is experiencing neck and arm pain, contact Dr. Kern Singh to schedule a consultation to receive the correct diagnosis and all your treatment options.

Dr. Kern Singh, MD is an internationally renowned spine surgeon specializing in outpatient minimally invasive and motion-preserving techniques and endoscopic spine surgery at Midwest Orthopaedics at RUSH and Professor in the Department of Orthopaedic Surgery at RUSH University Medical Center in Chicago, Illinois. Dr. Kern Singh is one of the nation’s Top 100 spine surgeons and is beloved by his patients for his compassionate care and excellent outcomes.  He welcomes nationally and internationally – based patients.

References

  • Donnally III CJ, Hanna A, Odom CK. Cervical Myelopathy. [Updated 2023 Jan 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482312/
At A Glance

Dr. Kern Singh

  • Minimally invasive and endoscopic spine surgeon
  • Inventor and surgeon innovator with multiple patents in spinal surgery and instrumentation
  • Author of more than 10 textbooks in minimally invasive spinal surgery
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