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If you have been diagnosed with spinal cord compression giving rise to the symptoms of myelopathy, you will almost certainly require surgery for this. Without surgery, this condition is invariably progressive, and the resultant neurological dysfunction is likely to be irreversible. The reason for this is simply that the spinal cord has very poor capacity for repair, and any damage done to the spinal cord as a consequence of pressure on it, is usually permanent. Surgery is therefore often done on an urgent basis to prevent neurological deterioration, and preserve the current level of function.

The precise surgical procedure for myelopathy depends on the cause of spinal cord compression, and the site. Given that the vast majority of myelopathy occurs in the cervical spine, the surgery will usually entail a decompression from either the front or the back of the neck. Very occasionally both of these procedures will need to be combined.

If the cause of the spinal cord compression is a disc prolapse, then it will be recommended that you have an anterior cervical discectomy as detailed in the brachialgia procedures section (hyperlink).

However, if the cause is more generalised narrowing of the spinal canal as a consequence of thickening of facet joints and ligaments and osteophyte formation (bony spurs), then a wider decompression from behind may be required. This is called a decompressive cervical laminectomy. This surgery will be carried out under a general anaesthetic with you in a prone position (facing down). It involves a vertical incision in the midline at the back of your neck, and the large muscles overlying the spine are mobilised away to expose the bony structures at the back of the spine. X-ray is used during the procedure to guide your surgeon to the precise point where the decompression is required. The spinous processes and lamina of the spine are then removed at the level(s) in question, along with the ligament at the back to the spine (the ligamentum flavum) which is almost always very thickened and contributing significantly to the spinal cord compression. It is usually possible to remove these structures without compromising the stability of the spine, however if there is concern about destabilising the spine, then metalwork can be placed to reinforce the spine.

Following a cervical laminectomy, pain can be more of an issue than with an anterior discectomy due to the greater muscle dissection involved. However, your experienced anaesthetist will be doing their utmost to ensure that discomfort is kept to a minimum. You are encouraged to start getting out of bed within the first 24 hours of surgery, as well as doing stretching exercises for your neck to try and minimise pain, muscle spasm and neck stiffness. You will usually be fit for discharge home within 2 or 3 days of surgery, although full recovery will take some weeks.

The neurological recovery following this surgery is variable. As mentioned above, the principal aim of a decompression is to halt any neurological deterioration, rather than improve your symptoms. Your surgeon will not be able to predict to what extent your pre-operative symptoms will be reversible, but the assumption should be that they will remain after surgery. However, in a proportion of patients, there will be some improvement, usually in a very gradual fashion. If there is an element of reversibility to your myelopathy, it may be as long as 18 months before you will see what the full extent of your recovery will be. Your surgeon will oversee your rehabilitation with appropriate rehabilitation specialists.