A 55-year-old presents with spastic paraparesis developing over 6 months and MRI reveals multilevel cervical cord compression (C3–C6) with intramedullary T2 signal changes at C4–C5. The diagnosis is cervical spondylotic myelopathy (CSM). The surgical approach preferred for multilevel (≥ 3 levels) central canal stenosis without significant kyphosis is:

• A Anterior cervical discectomy and fusion (ACDF) at all levels
• B Laminoplasty (open-door or French-door) as a motion-preserving posterior decompression ✓
• C Laminectomy alone without fusion
• D Posterior foraminotomy at each affected level

Explanation

For multilevel CSM (≥ 3 levels) with preserved or lordotic cervical alignment, laminoplasty (expansile cervical laminoplasty — Hirabayashi open-door or Kurokawa French-door) is the procedure of choice as it provides wide posterior decompression while preserving the posterior tension band and avoiding the morbidity of multilevel ACDF (pseudarthrosis, dysphagia, adjacent segment disease). Isolated laminectomy without fusion risks post-laminectomy kyphosis (swan-neck deformity). Foraminotomy addresses radiculopathy, not central cord compression.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.