HomeTreatmentsAboutBlogContact
ES/EN
Cervical spineMinimally invasive surgery

Spinal cord decompression for cervical myelopathy

Spinal cord decompression for cervical myelopathy (including cases due to ossification of the posterior longitudinal ligament, OPLL) is considered for patients with gait difficulty, hand clumsiness, tingling and neck stiffness from sustained cord compression. When symptoms progress and medication, physiotherapy or posture measures are no longer enough, decompressing the cord aims to protect neurological function and slow deterioration. It can be performed through anterior, posterior or combined approaches depending on the stenosis pattern and OPLL, with indication always personalised to clinical findings and imaging.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Medical illustration of spinal cord decompression for cervical myelopathy.

What is Spinal cord decompression for cervical myelopathy?

Spinal cord decompression for cervical myelopathy (e.g. due to ossification of the posterior longitudinal ligament – OPLL) includes techniques to enlarge the space for the cord in the cervical spine and relieve pressure. Compression may result from advanced arthritis, disc herniations, thickened ligaments or OPLL forming a rigid plate that narrows the canal. Depending on the case, the approach may be anterior, removing disc or vertebral bone, posterior (laminectomy, laminoplasty) or combined, always aiming to free the cord and nerve roots. Unlike surgeries focused on a single nerve root, this decompression addresses global cord involvement seen in multilevel stenosis and OPLL, with the goal of protecting neurological function over time.

Symptoms and warning signs

Cervical myelopathy often progresses insidiously. Watch for:

Difficulty walking, imbalance or a stiff, awkward gait
Hand clumsiness when buttoning, writing or handling small objects
Tingling, numbness or “electric shock” sensations in arms, hands or fingers
Neck stiffness, pain in the back of the neck or pressure in neck and shoulders
Red flags: progressive or sudden loss of strength, frequent falls, bowel or bladder changes or rapid worsening of symptoms

When is this procedure indicated?

Cervical myelopathy symptoms persisting or progressing despite conservative care
Significant cervical stenosis with cord compression on MRI/CT, with or without OPLL
Neurological progression: worsening gait, falls, increasing hand clumsiness or signs of cord damage
Pain and functional limitation affecting quality of life, independence and safety when walking
High risk of neurological decline without surgery, especially in OPLL and multilevel stenosis

How is the procedure performed?

1.Preoperative preparation

A detailed clinical and neurological assessment is performed with thorough MRI/CT review to define levels, stenosis pattern and strategy (anterior, posterior or combined). The neurosurgeon explains goals, alternatives and risks and answers questions. Fasting instructions are given, medication is reviewed (anticoagulants, antiplatelets and chronic treatments) and comorbidities are assessed with anaesthesia before signing consent.

2.During the procedure

Under general anaesthesia, decompression can be performed anteriorly, removing degenerated discs, bone fragments or OPLL compressing the cord and placing cages or grafts with plates and screws for stability. Posteriorly, laminectomy or laminoplasty widens the canal from behind and, if needed, fixation with screws and rods is added. In some cases both approaches are combined to achieve complete decompression and sufficient stability.

3.Immediate postoperative period

After surgery, the patient stays in recovery where breathing, blood pressure, neurological status and pain are monitored. Then they return to the ward, with regular checks of strength, sensation and gait. Mobilisation usually begins the next day with physiotherapy. Typical hospital stay is 3–5 days, adjusted to complexity, neurological course and comorbidities.

Recovery and daily life

Recovery is usually gradual. In the first days, neck pain, fatigue and some gait insecurity are common; basic mobilisation starts early under supervision. Neurological improvement may be progressive and sometimes partial: the main goal is to slow myelopathy progression and recover function when possible. Return to office work is often considered between 6 and 8 weeks; physical or demanding jobs may require 3–4 months or more. Physiotherapy, gait retraining, cervical and dorsal strengthening and daily ergonomics are essential. If fever, severe pain, new weakness or sudden gait worsening occurs, prompt review is needed.

Risks and possible complications

As with any spine surgery, especially when involving the cord, there are risks. General risks include anaesthesia-related problems, infection, bleeding, haematoma and venous thrombosis. Specific risks include spinal cord or nerve root injury that could worsen strength or sensation, persistence or lack of myelopathy improvement, instability if not stabilised adequately, pseudoarthrosis when fusion is performed, residual or chronic neck pain and, in OPLL, technical difficulty removing rigid bone plates adherent to the cord. Long-term cervical alignment changes may also occur. These risks are weighed against the risk of neurological progression without surgery.

Frequently asked questions

It usually takes between 2 and 4 hours depending on levels involved, need for anterior, posterior or combined approach, and OPLL complexity. Additional time is needed for operating room preparation and initial recovery in the PACU. Your team will give an approximate time for your case.
You will not feel pain during surgery because it is under general anaesthesia. In the following days, neck and muscle pain are common but usually manageable with medication and comfort measures. Neck pressure and gait stability often improve gradually, though neurological recovery can be slow.
For office-based work, return is often considered between 6 and 8 weeks if pain control and neurological course are adequate. Physical jobs with lifting or fall risk may require 3–4 months or more, decided individually during follow-up.
Walking and gentle activities are encouraged early with gradual increases. High-impact or contact sports and activities requiring wide neck movements are usually reintroduced very gradually from around 3–4 months, depending on recovery and guidance from your surgeon and rehabilitation team.
Surgery aims to halt progression and free the cord; recurrence of the same stenosis at treated levels is unlikely, though the cord may not fully recover if damage was advanced. Other segments can degenerate over time, so follow-up and healthy habits matter.
This decompression targets the spinal cord in global or multilevel stenosis (including OPLL), while discectomy or foraminotomy focus on a specific nerve root. It is typically more complex and extensive because it aims to protect cord function, not just relieve arm pain.
Not always, but OPLL and cervical myelopathy often carry risk of progression. Mild, stable cases may be observed closely; with progression or significant neurological involvement, decompression is usually the reasonable option. The decision is personalised.

Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala