Figure 410

(A) Cord edema/myelomalacia at C3 through C6 levels is easy to depict in the sagittal T2-weighted images. (B) Axial T2-weighted image showing the "cobra eyes" sign.

Decompressive surgery is recommended in patients with progressive neurological loss or patients whose quality of life is affected to a great extent. The timing of surgery in patients with cervical myelopathy is of paramount importance and quite challenging. Procrastination in the face of clear neurological deterioration may result in permanent disability. When evidence for cord compression, cord signal changes, or cord atrophy is present the patient may not regain lost function even after adequate decompression. Patients with up to three myelopathic levels can be safely operated on in an anterior approach. Patients with more extensive disease involving four or five levels may fare better with the posterior approach as the rate of complications of the anterior approach rises in such extensive disease. Cervical laminoplasty may be the procedure of choice for patients with extensive multilevel disease who are operated on in the posterior approach.

Lumbar stenosis patients whose symptoms interfere with their quality of life should be referred for decompression. Wide laminec-tomies and facetectomies may provide permanent relief. Stabilization with pedicle screws bilateral lateral fusion allows early mobilization.

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