Treatment options

When it comes to managing cervical myelopathy, a range of treatment options exists, tailored to the severity of the condition and individual circumstances. The primary objectives of treatment are to alleviate symptoms, prevent further deterioration, and enhance overall quality of life.

For mild cases, non-surgical approaches are typically considered first. Physical therapy plays a crucial role in the management of cervical myelopathy. A physical therapist can design a customized exercise program to strengthen the muscles surrounding the cervical spine, improve flexibility, and enhance overall mobility. They may also incorporate techniques to improve posture and body mechanics, reducing stress on the affected area.

Medications may be prescribed to manage specific symptoms associated with cervical myelopathy. Nonsteroidal anti inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Muscle relaxants may be prescribed to alleviate muscle spasms. In some cases, corticosteroid injections into the affected area may be recommended to provide temporary relief.

In more severe cases or when symptoms progress, surgical intervention may be necessary. The specific surgical procedure will depend on the underlying cause and extent of spinal cord compression. Common surgical interventions for cervical myelopathy include decompression surgery and spinal fusion.

Decompression surgery involves removing or trimming the structures causing pressure on the spinal cord. This may involve removing portions of the vertebral bone, herniated discs, or bone spurs. By creating more space for the spinal cord, decompression surgery aims to relieve pressure and improve nerve function.

Spinal fusion is often performed in conjunction with decompression surgery. It involves fusing two or more vertebrae together using bone grafts, metal plates, or screws. Spinal fusion stabilizes the affected segment of the cervical spine, reducing the risk of further degeneration and maintaining proper alignment.

In my case my surgeon opted for Anterior Corpectomy

Anterior corpectomy is a surgical procedure commonly performed to alleviate cervical myelopathy caused by spinal cord compression. It involves the removal of the vertebral body and adjacent intervertebral discs to decompress the spinal cord and nerve roots in the cervical spine.

Procedure Overview:

1. Anesthesia: The patient is placed under general anesthesia to ensure comfort and complete relaxation during the procedure.

2. Incision: A small horizontal or oblique incision is made in the front of the neck (anterior approach) to access the affected area of the cervical spine.

3. Exposure: The soft tissues, including the muscles and blood vessels, are carefully retracted to expose the vertebral bodies and intervertebral discs involved in the compression.

4. Discectomy: The surgeon removes the intervertebral discs adjacent to the affected vertebral body to achieve decompression of the spinal cord and nerve roots. This step is crucial for relieving pressure and restoring the space required for proper nerve function.

5. Corpectomy: The affected vertebral body, including any associated bone spurs or tumor masses, is meticulously removed. This process involves cutting through the vertebral body on both sides and carefully extracting it.

6. Stabilization: After the corpectomy, the resulting void in the spine needs to be filled and stabilized. This is accomplished by inserting a bone graft or a synthetic cage into the space previously occupied by the vertebral body. The graft or cage promotes fusion between the adjacent vertebral bodies, providing stability and preventing abnormal movement.

7. Instrumentation: In some cases, the surgeon may choose to enhance stability by placing metal plates, screws, or rods along the front of the spine. These instruments fixate the adjacent vertebrae, providing additional support during the fusion process.

8. Closure: The incision is carefully closed with sutures, and a sterile dressing is applied to the surgical site.

Pros of Anterior Corpectomy:

1. Direct Decompression: Anterior corpectomy allows direct access to the affected area of the cervical spine, providing the surgeon with a clear view of the spinal cord and nerve roots. This enables precise removal of the compressive structures, effectively relieving pressure on the spinal cord and nerves.

2. Restoration of Space: By removing the affected vertebral body and adjacent discs, anterior corpectomy creates additional space within the spinal canal. This restoration of space helps alleviate the compression, allowing for improved nerve function and potential resolution of
symptoms.

3. Fusion and Stability: The use of bone grafts, synthetic cages, and instrumentation promotes spinal fusion and stabilization. This can help prevent further degeneration, maintain proper alignment, and potentially reduce the risk of recurrent compression or instability.

Cons of Anterior Corpectomy:

1. Surgical Complexity: Anterior corpectomy is a technically demanding procedure that requires expertise in spinal surgery. The intricate nature of the surgery and proximity to vital structures, such as blood vessels and the esophagus, poses potential risks and complications.

2. Longer Recovery Time: The extensive nature of anterior corpectomy surgery typically results in a longer recovery period compared to less invasive procedures. Rehabilitation, physical therapy, and close follow-up with healthcare professionals are crucial to optimize recovery and regain functionality.

As with any surgical procedure, the decision to undergo anterior corpectomy should be made after careful consideration of the individual patient’s condition, symptoms, overall health, and discussion with the treating physician. The surgeon’s expertise and experience significantly influence the success and outcomes of the procedure.

Please note that this description is provided for informational purposes only and should not replace the advice of a qualified healthcare professional. Pros and cons may vary depending on individual circumstances and should be discussed with a physician specializing in spinal surgery.