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Types of Operation

Types of Operations

There are a large number of different types of operations used to treat CSM. The common aim of surgery is to decompress the spinal cord. In addition, it may be advisable or necessary to stabilise the spine in order to prevent further progression of degenerative changes. The exact type of procedure offered varies from country to country and from surgeon to surgeon. At present, there is no clear evidence that one type of operation is better than another.

Surgery team

This page aims to give an overview of surgical options. The information may be useful when discussing potential treatments with a surgeon. However, the information provided is by no means complete and it is the responsibility of the patient and the surgeon to cover all aspects required to make a sound decision.

We have included links to patient information sheets of common operations with further details, including potential side effects and potential complications.

Surgery from the Front

Surgery from the front is often considered when the cord is primarily compressed from the front. The approach to the spine usually entails a 3cm incision in the neck. The spine can be reached leaving the main arteries of the neck on one side and the trachea and oesophagus on the other side. Space is created by either removing the compressing discs, or, in some cases by also removing the front of the vertebra. The space is usually filled with a graft, which can include bone or a metallic or plastic implant.

This operation is often well tolerated by patients. Transient side effects can include hoarseness and difficulties swallowing. 

For further information see our anterior discectomy patient information sheet.

Surgery from the Back

In some cases, compression occurs mainly from behind, or it extends over multiple levels as in the image shown. In these cases, a surgeon will often choose a “posterior” approach, which will lead him to the spine from behind. Although this seems may seem as a “less invasive” procedure, discomfort after the operation is often worse than after an “anterior approach”. Furthermore, a posterior approach may require “instrumentation and fusion” to support the spine. 

Cervical spine

The main advantages are that surgery from behind is able to deal with multiple levels of spinal cord compression. 

More information can be found on our patient information sheet.

Instrumentation and Fusion

Operated spine

Operated spine

In some cases, it is necessary to fortify the spine. This is often achieved using titanium screws that are inserted into parts of the vertebra adjacent to the spinal cord. Connecting the screws with metal rods on each side adds strength to the spine. This operation is technically even more challenging and commonly only performed by dedicated spine surgeons. 

The risks of inserting the screws include injury to the spinal cord or nerves and important arteries leading up to the brain. 

See patient information for cervical instrumentation.

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