Posterior microsurgical decompression for cervical spondylotic myelopathy: study protocol

Objective. To determine the clinical efficacy of bilateral microsurgical decompression through a unilateral approach in comparison with decompressive laminectomy and posterior screw fixation in patients with cervical spondylotic myelopathy.

Material and Methods. The study will include adult patients with neurological deficits caused by cervical compressive-ischemic myelopathy due to degenerative spinal canal stenosis. The study will include two groups of patients: a prospective (study) group undergoing bilateral microsurgical decompression of intracanalicular neurovascular structures through a unilateral approach, and a retrospective (comparison) group undergoing decompressive laminectomy with screw fixation. The duration of the study will be approximately two years. The dynamics of clinical, radiological, and neuroimaging data will be assessed at 3 and 12 months.

Expected Results. This study will clarify the efficacy parameters of bilateral microsurgical decompression of intracanalicular neurovascular structures through a unilateral approach in the cervical spine, and demonstrate the advantages of this technique over the conventional method of decompressive laminectomy with screw fixation at the cervical level. 

1. Badhiwala JH, Ahuja CS, Akbar MA, Witiw CD, Nassiri F, Furlan JC, Curt A, Wilson JR, Fehlings MG. Degenerative cervical myelopathy – update and future directions. Nat Rev Neurol. 2020;16:108–124. DOI: http://dx.doi.org/10.1038/s41582-019-0303-0

2. Rutnagur J, Frost A, Arora M, Lowrie J, Baliga S. Acute spinal problems in the elderly. Br J Hosp Med (Lond). 2025;86:1–16. DOI: http://dx.doi.org/10.12968/hmed.2024.0545

3. Houten JK, Shahsavarani S, Verma RB. The natural history of degenerative cervical myelopathy. Clin Spine Surg. 2022;35:396–402. DOI: http://dx.doi.org/10.1097/BSD.0000000000001405

4. Pope DH, Mowforth OD, Davies BM, Kotter MRN. Diagnostic delays lead to greater disability in degenerative cervical myelopathy and represent a health inequality. Spine (Phila Pa 1976). 2020;45:368–377. DOI: http://dx.doi.org/10.1097/BRS.0000000000003305

5. Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord. 1991;4:286–295. DOI: http://dx.doi.org/1097/00002517-199109000-00005

6. Martin AR, Jentzsch T, Wilson JRF, Moghaddamjou A, Jiang F, Rienmueller A, Badhiwala JH, Akbar MA, Nater A, Oitment C, Ganau M, Massicotte EM, Fehlings MG. Inter-rater reliability of the modified japanese orthopedic association score in degenerative cervical myelopathy: a cross-sectional study. Spine (Phila Pa 1976). 2021;46:1063–1069. DOI: http://dx.doi.org/10.1097/BRS.0000000000003956

7. Kong LD, Meng LC, Wang LF, Shen Y, Wang P, Shang ZK. Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy. Exp Ther Med. 2013;6:852–856. DOI: http://dx.doi.org/10.3892/etm.2013.1224

8. Bak AB, Alvi MA, Moghaddamjou A, Fehlings MG. Comparison of outcomes after anterior versus posterior surgery for degenerative cervical myelopathy: a pooled analysis of individual patient data. Spine J. 2025;25:1964–1973. DOI: http://dx.doi.org/10.1016/j.spinee.2025.03.027

9. Lee CH, Lee J, Kang JD, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine. 2015;22:589–595. DOI: http://dx.doi.org/10.3171/2014.10.SPINE1498

10. Han SH, Kim SH, Noh SH, Lee JJ, Ha Y, Cho PG. Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion. Spine J. 2025;25:2413–2421. DOI: http://dx.doi.org/10.1016/j.spinee.2025.04.017

11. Highsmith JM, Dhall SS, Haid RW Jr, Rodts GE Jr, Mummaneni PV. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine. 2011;14:619–625. DOI: http://dx.doi.org/10.3171/2011.1.spine10206

12. Singrakhia MD, Malewar NR, Singrakhia SM, Deshmukh SS. Cervical laminectomy with lateral mass screw fixation in cervical spondylotic myelopathy: neurological and sagittal alignment outcome: do we need lateral mass screws at each segment? Indian J Orthop. 2017;51:658–665. DOI: http://dx.doi.org/10.4103/ortho.IJOrtho_266_16

13. Mielke D, Rohde V. Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir (Wien). 2015;157:1813–1817. DOI: http://dx.doi.org/10.1007/s00701-015-2549-7

14. Chen C, Yang C, Yang S, Gao Y, Zhang Y, Wu X, Hua W, Shao Z. Clinical and radiographic outcomes of modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2019;44:1697–1704. DOI: http://dx.doi.org/10.1097/BRS.0000000000003158

15. Soliman MAR, Khan S, Ruggiero N, Mariotti BL, Aguirre AO, Kuo CC, Fritz AG, Sharma S, Nezha A, Levy BR, Khan A, Salem AA, Jowdy PK, Zeeshan Q, Ghannam MM, Starling RV, Pollina J, Mullin JP. Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws. Neurosurg Rev. 2022;45:1941–1950. DOI: http://dx.doi.org/10.1007/s10143-022-01750-2

16. Singh DK, Kumar V, Yadav K, Mohammad K, Sharma PK. Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy: An institutional experience. J Craniovertebr Junction Spine. 2022;13:357–363. DOI: http://dx.doi.org/10.4103/jcvjs.jcvjs_51_22

17. De la Garza-Ramos R, Xu R, Ramhmdani S, Kosztowski T, Bydon M, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2016;24:885–891. DOI: http://dx.doi.org/10.3171/2015.10.SPINE15795

18. Hernandez RN, Wipplinger C, Navarro-Ramirez R, Soriano-Solis S, Kirnaz S, Hussain I, Schmidt FA, Soriano-Sánchez JA, Härtl R. Ten-step minimally invasive cervical decompression via unilateral tubular laminotomy: technical note and early clinical experience. Oper Neurosurg. 2020;18:284–294. DOI: http://dx.doi.org/10.1093/ons/opz156

19. Clark JG, Abdullah KG, Steinmetz MP, Benzel EC, Mroz TE. Minimally invasive versus open cervical foraminotomy: a systematic review. Global Spine J. 2011;1:9–14. DOI: http://dx.doi.org/10.1055/s-0031-1296050

20. Dorow M, Lobner M, Stein J, Konnopka A, Meisel HJ, Gunther L, Meixensberger J, Stengler K, Konig HH, Riedel-Heller SG. Risk factors for postoperative pain intensity in patients undergoing lumbar disc surgery: a systematic review. PLoS One. 2017;12:e0170303. DOI: http://dx.doi.org/10.1371/journal.pone.0170303

21. Wang X, Ji X. Sample size estimation in clinical research: from randomized controlled trials to observational studies. Chest. 2020;158(1S):S12–S20. DOI: http://dx.doi.org/10.1016/j.chest.2020.03.010

22. Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010;10:469–474. DOI: http://dx.doi.org/10.1016/j.spinee.2010.02.007

23. Roberts C, Torgerson DJ. Understanding controlled trials. Baseline imbalance in randomised controlled trials. BMJ. 1999;319(7203):185. DOI: http://dx.doi.org/10.1136/bmj.319.7203.185

24. Huang M, Gao X, Cheng J, Han J, Liu J. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: A meta-analysis. Medicine (Baltimore). 2016;95:e03588. DOI: http://dx.doi.org/10.1097/MD.0000000000003588 Erratum in: Medicine (Baltimore). 2016;95:e0916. DOI: http://dx.doi.org/10.1097/01.md.0000489580.04709.16

25. Ghogawala Z. Anterior cervical option to manage degenerative cervical myelopathy. Neurosurg Clin N Am. 2018;29:83–89. DOI: http://dx.doi.org/10.1016/j.nec.2017.09.005

26. Balmaceno-Criss M, Singh M, Daher M, Buchbinder R, Diebo BG, Daniels AH. Degenerative cervical myelopathy: history, physical examination, and diagnosis. J Clin Med. 2024;13:7139. DOI: http://dx.doi.org/10.3390/jcm13237139

27. Huang K, Li S, Dai Y, Xu D, Chen G, He Y, Fan Z, Teng H. Machine learning-based prediction for axial pain following expansive unilateral open-door laminoplasty: a retrospective cohort study. Pain Ther. 2026;15:291–309. DOI: http://dx.doi.org/10.1007/s40122-025-00802-x