Timing of Operative Intervention

Cervical spondylotic myelopathy (CSM) is caused by damage to the spinal cord from progressive, age-related degenerative narrowing of the spinal canal. Regardless of the degree of narrowing, signs and symptoms can vary widely for each individual patient with CSM. Currently there are no universally accepted guidelines regarding the timing of surgery for CSM. Surgical decision-making for CSM requires complex integration of each patient’s symptoms, physical exam findings, radiographic findings, patient lifestyle, and overall health. These characteristics can then be used to stratify patients with CSM into asymptomatic, mild, moderate, and severe disease categories. This chapter aims to provide evidence-based recommendations to determine the need and timing of surgical decompression in patients with CSM based upon disease severity category.