Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?

Indications and timing of surgical treatment for cervical radiculopathy and myelopathy, and the long-term results for the conditions, were reviewed. A dvances in spinal imaging and accumulation of clinical experience have prov ided some clues as to indications and timing of surgery for cervical myelop athy. Duration of myelopathy prior to surgery and the transverse area of th e spinal cord at the maximum compression level were the most significant pr ognostic parameters for surgical outcome. Thus, when myelopathy is caused b y etiological factors that are either unchangeable by nature, such as devel opmental canal stenosis, or progressive, such as ossification of the poster ior longitudinal ligament, surgical treatment should be considered. When an etiology of myelopathy is remissible, such as soft disc herniation and lis thesis, surgery may be reserved until the effects of conservative treatment are confirmed. When surgery is properly carried out, long-term surgical re sults are expected to be good and stable, and the natural course of myelopa thy secondary to cervical spondylosis may be modified. However, little atte ntion has been paid to the questions "When and what can surgery contribute to treatment of cervical radiculopathy?". A well-controlled clinical study including natural history should be done to provide some answers.