Patients who are poor medical candidates or for another reason are treated nonoperatively must be followed closely for worsening of myelopathy. The surgical options are anterior or posterior decompression. Anterior approaches are similar to that described for herniated cervical disc and may be performed at multiple levels as appropriate. A bony graft is placed for fusion. With long grafts, a plate and screws are usually placed.
Posterior decompression involves laminectomy at the affected levels.
The effectiveness of posterior decompression is contoversial, but most surgeons today would probably prefer an anterior procedure when feasible. The effect of age is probably related to advanced disease.