If the symptoms are mild, non-surgical treatment can be effective. For those patients who are not surgical candidates, these treatments may be used to manage symptoms on a long term basis. For those patients who present with signs and symptoms of spinal cord compression, urgent surgical intervention is indicated. For cervical stenosis, either anterior or a posterior approachs can be used. Because most patients are elderly, they usually have comorbidity from cardiac or pulmonary problems.
Multilevel decompression requires general anesthesia and significant blood loss is possible.
It is very important for these patients to be evaluated by a cardiologist or pulmonologist before surgery. Many of these patients are taking anti-platelet medications. If possible, they should discontinue these drugs 1 week prior to the operation. Lumbar laminectomy is straightforward. To obtain effective decompression of the lateral recess the surgeon should remove the medial part of the hypertrophic facet joint.