الفهرس 
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Abstract
Cervical spondylotic myelopathy (CSM) is defined as spinal cord dysfunction secondary to extrinsic compression of the cord or its vascular supply, or both, that is caused by degenerative disease of the cervical spine. It is the most common type of spinal cord dysfunction in patients who are older than 50 years of age it is associated with congenital or developmental stenosis of the cervical canal. Degenerative changes of the cervical spine include changes of the bony discoligamentous structures that can create mechanical alteration of the anatomy. Encroachment on the available space in the spinal canal results from osteophytic spurring of the facet and uncovertebral joints, results in spinal cord pathological changes these changes include cortico-spinal tract degeneration destruction of anterior horn cells, demyelination of lateral and dorsolateral tracts. Free radical and cation mediated cell injury, and apoptosis have relevance to the path physiology of CSM. The compressive syndromes and deformation or instability represent basic indication for surgery. In this work 20 patients diagnosed as having CSM had been surgically treated by prospective plane in the period from October 2013 till April 2014. The surgical treatment was performed by one of two methods 17 patients were treated by discectomy and fusion using cervical (PEEK) cages, while 3 cases operated by posterior approach through cervical laminectomy. The ages ranged from 40 years – 75 years old with mean age 56.1 years old. The diagnosis of CSM based on careful history, taking complete physical and neurological examination, radiographic documentation.
Most of the patients were complaining from abnormal gait and difficulty in doing fine movements of the hands. Neck pain was prominent, symptom in all cases. The duration of symptoms in this work ranged from 9 months to 4 years with the mean 2 years. The long tract signs were the hallmark signs of myelopathy. The patients were assessed and graded according to Nurick’s grading system for gait and Japanese Orthopedic Association scale (JOA) for hand function. Patients operated by one of two methods, anterior cervical discectomy and fusion and posterior decompression through cervical laminectomy. There were 12 cases with one level anterior decompression, 3 cases with double level decompression; two cases had 3 levels decompression. Three cases operated by cervical laminectomy. All cases were investigated by Plain X-ray and MRI. Cervical kyphosis or swan neck, osteophytes (anterior and posterior) narrow disc spaces and exclusion (of developmental stenosis) were the most important radiological findings in plain X-ray while in MRI Ventral compression of the cord was found in 17 cases, while posterior compression was found in 3 cases. 18 patients had cord malacia, while in two patients there were no cord changes. Follow up was done clinically and radiologically, immediate post-operative (clinically) and before discharge post-operative for all cases, and clinically and radiologically after six months The overall results in this thesis at follow-up were: 1. The patients operated by anterior discectomy and fusion with cervical cages (17 cases):
Excellent 10 patients 50% - Good 3 patients 15%. - Fair 2 patients 10% - Poor 2 patients 10%. The percentage of excellent and good recovery was 65% and failure group 20%. 2. The patients operated by cervical laminectomy (3 cases): -Excellent one patient 5%. - Good 1 patient 5%. -Fair 1 patient 5%. The percentage of excellent and good recovery was 10% and failure group was 5%. The minimum hospital stay was 4 days post-operative and the maximum was 15 days post-operative. Conclusion: Any old age patient complaining from difficult gait must be fully examined neurologically to exclude CSM. Inspection of patients gait is very important in diagnosis as this will direct the attention of the clinician to the diagnosis of CSM. A Plain X-ray and MRI are the gold standard for diagnosis of CSM. The corner stone for excellent and good outcome of cervical spondylotic myelopathy is early diagnosis as this will lead to low grade myelopathy absence of cord changes and short duration of symptoms.
Choosing the surgical technique depends mainly on the site of the pathology whether anterior or posterior. Many surgical modalities co-exists in the management of cervical myelopathy including, ventral and dorsal approaches with and without fusion. The prognosis doesn’t depend on the type of surgery, but it depends mainly on the age of the patient, severity of myelopathy, duration of symptoms, and cord changes of the MRI. In this work, there was progressive improvement in gait and hand function started from the first week postoperative. The radiculopathy and bladder dysfunction were the first symptoms to disappear.