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Cervical Myelopathy

CERVICAL SPONDYLOTIC MYELOPATHY:
SURGICAL TREATMENT OPTIONS

One of the most common neck conditions that occurs with age is cervical spondylotic myelopathy (CSM). Over time, the normal wear-and-tear effects of aging can lead to a narrowing of the spinal canal. This compresses — or squeezes — the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, and weakness (AAOS, 2015).

Symptoms usually begin after the age of 50, but can occur earlier if there was an injury to the spine at a younger age. Many people with CSM will have steady progression of their disease.

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Once symptoms start, they tend to continue. Typically, the disease progresses slowly over several years. In about 5% to 20% of people, CSM worsens more rapidly.

CONSULT

We will consider many options regarding treatment for cervical myelopathy, including your overall health, and will discuss the advantages and disadvantages of surgical interventions.

People who have progressive neurologic changes (such as weakness, numbness, or falling) with signs of severe spinal cord compression or spinal cord swelling are candidates for surgery. Patients with severe or disabling pain may also be helped with surgery.

People who experience better surgical outcomes often have these characteristics:

  • The symptom of an electrical sensation that runs down the back and into the limbs
  • Younger age
  • Shorter duration of symptoms
  • Single rather than multiple areas of involvement
  • Larger areas available for the cord

TREATMENT

Patients with overt spinal cord compression resulting in spinal cord dysfunction (myelopathy) may be referred directly for consideration of surgery. Two common indications for having surgery include:

  1. Symptoms failing to improve after 4 to 6 weeks of non-surgical management
  2. Progression of the symptoms in spite of non-surgical treatment

In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to relieve pressure on the spinal cord has been the procedure of choice.

Depending on the patient’s anatomy, many surgeons prefer anterior decompression of the spinal cord and nerve roots (in the front of the spine).

These procedures are referred to as anterior cervical decompression and fusion operations. The surgeon may also use instrumentation (plates and screws) to provide immediate internal support for the cervical spine, and to promote bone graft healing.

SURGICAL OPTIONS

There are many successful surgical techniques for treating CSM. The goal of surgery is to open the space for the spinal cord, or “decompress” the spinal canal. The decompression is performed either from the front of your neck (anterior) or the back (posterior). Each approach has its advantages and disadvantages and these should be discussed with your surgeon. Neither surgical approach is ideal for every patient.

Anterior approach:

  • Anterior cervical discectomy and fusion
  • Anterior cervical corpectomy and fusion

Posterior approach:

  • Laminectomy
  • Laminoplasty

Each option comes with its own set of benefits and risks. Call today for a consultation with spine expert Hamid Mir M.D. (949) 988-7848.

Orthopedic Spine Surgeon Dr Hamid R. Mir M.D.

Meet

Dr. Hamid R. Mir M.D.

Orthopedic Spine Surgeon & Back, Spine, & Neck Specialist

Dr Hamid Mir is a board certified orthopedic spine surgeon & back, spine, & neck specialist with fellowship training in combined neurosurgery and orthopedic spine surgery. He has offices in Orange County, Los Angeles & Riverside. Dr Mir specializes in spinal fusion, lumbar surgery and treating trauma as well as other conditions affecting the lumbar, thoracic, and cervical spine including degenerative diseases, stenosis, fracture, infection, adult scoliosis, revision, and complex reconstructions.

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Testimonials

You are more than just a patient.

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I was in a very bad situation with a herniated disc in my lower back so I made an appointment with DISC spine center and Dr. Hamid. He was very professional and made me comfortable that he understood exactly what I was going through and was able to communicate effectively exactly what it will take to get me on the road to recovery after spine surgery. It took several months as my injury was severe however I always felt I was in good hands under Dr. Hamid’s supervision…If you ever have the misfortune of injuring your circuit board of your body (spine) you need a pro, do not take advice from anyone who’s not specifically licensed to help, Dr Hamid is who I chose and I’m very thankful.

- Matteo B

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Dr. Mir saw me about 2 months before the spine procedure and indicated that I had severe stenosis or narrowing of the openings where the nerve roots exit at the L4, L5 and S1 level. He reviewed my MRI and without wasting any time, asked if I wanted or was considering spinal surgery. He was extremely clear and answered all my questions. I had the procedure done at the Disc Newport OP surgery spine center and was cared for by an incredibly competent, caring staff. I was discharged same day and my post op recovery was 2 weeks, and returned to daily activities and work July 15th. The procedure was very successful as my back pain is basically gone. Amazing relief from a procedure done by a great surgeon with a great team!

- Stan W.

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Dr Mir is an excellent spine surgeon. I had a surgery on my neck by another surgeon but I was still in pain. A friend who had prior spine surgery with Dr. Mir recommended him to me. As the treating surgeon he was very detail oriented, confident, and knowledgeable. His team is very friendly and helpful. I decided to have a second cervical spine operation on my neck. Soooo thankful I have no pain and for physical medicine doctors like him.

- Hillary C.

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Dr. Mir and his entire team of specialists take the extra time and consideration to shape alternatives to meet the needs (holistically) of the patient. Everything about the experience of my surgery was positive. Dr. Mir is a patient and compassionate surgeon. His communication skills are remarkably attentive. We are six months out of the starting gate from surgical treatment, and with PT and core strengthening exercises, this 65 yr. old is back to regular training for next year’s marathon. Thank you kindly El Doc-tor….you are amazing! See you soon.

- Lorena B.

Dr. Hamid Mir is a member of American Board of Orthopedic Surgery with fellowship training in combined neurosurgical and orthopedic spine surgery at Cedars Sinai Medical Center in 2004. As a top rated spine surgeon, he specializes in cervical, thoracic, and lumbar spine diseases including degenerative, stenosis, fracture, infection, scoliosis, revision, and complex reconstructions.

Dr. Mir focused his practice on minimally invasive techniques. As Medical Director of DISC Sports & Spine Center, Dr. Mir is at the forefront of the field of minimally invasive spine surgery. The benefits of these techniques include less post-operative pain, quicker recovery reduced blood loss, less soft tissue damage, smaller surgical incisions, less scarring and improved function.

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