Personalized Surgical Strategy in Cervical Myelopathy: Case Series with Anterior and Posterior Approaches

Introduction: Cervical myelopathy is a progressive condition that often requires surgical decompression. The anterior and posterior approaches are the most commonly used. The choice should be individualized, based on the number of affected levels, presence of ossification of the posterior longitudinal ligament (OPLL), cervical alignment, and bone quality. Case Series: Three patients underwent posterior approach due to multilevel stenosis, OPLL, and preserved alignment. Laminectomies, with or without fusion, were safe and effective. The other three patients were treated via anterior approach. In cases with soft disc herniation, localized anterior compression, or osteoporosis, anterior cervical discectomy and fusion (ACDF) was chosen, resulting in good functional recovery. Discussion: Surgical decisions must consider the location of compression, disease extent, sagittal alignment, and comorbidities. The posterior approach is preferred in multilevel stenosis with ossification. The anterior approach allows direct decompression in localized compression. Both approaches show similar long-term outcomes when properly indicated. Intraoperative monitoring contributes to surgical safety, as demonstrated in one case. Conclusion: The choice of surgical approach in cervical myelopathy must be individualized. Detailed anatomical and clinical evaluation guides the optimal strategy, aiming for safety and favorable functional outcomes.