The Surgical Management of Cervical Spinal Stenosis, Spondylosis, and Myeloradiculopathy by Means of the Posterior Approach

Abstract

No firm statistical evidence exists establishing the superiority of the anterior or the posterior approach in the management of spondylostenosis, although some sense of order is evolving. In general the consensus suggests that in spondylostenosis, the anterior approach may be preferred for disc or segmental osteophyte intrusions limited to one or two levels. Laminectomy is the preferred procedure in patients with a narrowed canal and multiple level involvement. The surgeon's personal preference and experience remains the dominant factor. Patients with congenital stenosis involving all of the major segments, with or without superimposed developmental changes, require more extensive laminar decompression with proper attention to the craniocervical junction where anomalies may occur. The success of laminectomy is dictated by the preservation of cervical lordosis. In patients with major dorsally located abnormalities such as hyperlordosis, shingling, and arthrosis with hypertrophy of the yellow ligaments, posterior decompression is essential. Subsequent stabilization is rarely required with proper surgical and postoperative care. Both an anterior and posterior approach may be indicated in unique circumstances of spondylostenosis complicated by subluxation and instability.