Personalized Surgical Strategy in Cervical Myelopathy: Case Series with Anterior and Posterior Approaches
Pedro Nogarotto Cembraneli, Julia Brasileiro de Faria Cavalcante, Italo Nogarotto Cembraneli, Renata Brasileiro de Faria Cavalcante, José Edison da Silva Cavalcante, Rodrigo Correia de Alcântara, Marcos Daniel Xavier, Vitor Cesar Machado, Alessandro Fonseca Cardoso and Chrystiano Fonseca Cardoso
Introduction: Cervical myelopathy is a progressive condition that often requires surgical decompression.
The anterior and posterior approaches are the most commonly used. The choice should be individualized,
based on the number of affected levels, presence of ossification of the posterior longitudinal ligament
(OPLL), cervical alignment, and bone quality. Case Series: Three patients underwent posterior
approach due to multilevel stenosis, OPLL, and preserved alignment. Laminectomies, with or without
fusion, were safe and effective. The other three patients were treated via anterior approach. In cases
with soft disc herniation, localized anterior compression, or osteoporosis, anterior cervical discectomy
and fusion (ACDF) was chosen, resulting in good functional recovery. Discussion: Surgical decisions
must consider the location of compression, disease extent, sagittal alignment, and comorbidities. The
posterior approach is preferred in multilevel stenosis with ossification. The anterior approach allows
direct decompression in localized compression. Both approaches show similar long-term outcomes
when properly indicated. Intraoperative monitoring contributes to surgical safety, as demonstrated in
one case. Conclusion: The choice of surgical approach in cervical myelopathy must be individualized.
Detailed anatomical and clinical evaluation guides the optimal strategy, aiming for safety and favorable
functional outcomes.
