Cervical Myelopathy Surgery in New York City

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

Cervical myelopathy is one of the most serious and commonly missed conditions in spine medicine. It occurs when the spinal cord in the neck is compressed — not just the nerve roots, but the cord itself — leading to a progressive pattern of neurological dysfunction that can affect the hands, arms, legs, and bladder. Unlike a pinched nerve, which causes pain and numbness in a specific distribution, myelopathy causes a broader, more insidious decline in function that patients and physicians alike often attribute to aging or other causes.

The critical fact about cervical myelopathy is this: it does not reliably improve on its own. Without surgical decompression, most patients will plateau at best and continue to worsen at worst. The good news is that surgery, when performed at the right time by an experienced surgeon, can halt progression and in many cases produce meaningful functional improvement.

Dr. Sardar specializes in the surgical treatment of cervical myelopathy and performs the full range of decompressive procedures — from anterior approaches including ACDF and cervical disc replacement to posterior laminoplasty and laminectomy with fusion. He tailors the surgical approach to each patient’s anatomy, disease severity, and cervical alignment.

WHAT IS CERVICAL MYELOPATHY?

Cervical myelopathy is spinal cord dysfunction caused by compression of the cervical spinal cord. The cervical spine — the neck — is the most common site of spinal cord compression in adults. As the discs degenerate and bone spurs form with age, the spinal canal can narrow to the point where the cord is compressed between degenerative structures in front and thickened ligaments behind. This is called cervical spondylotic myelopathy (CSM), the most common form of the condition.

Other causes of cervical myelopathy include disc herniation, ossification of the posterior longitudinal ligament (OPLL), instability, trauma, and deformity. In all cases, the result is the same: the spinal cord is compressed, its blood supply may be compromised, and neurological function declines.

SIGNS & SYMPTOMS

Cervical myelopathy presents differently from a simple pinched nerve. Symptoms often develop gradually and are easy to overlook or misattribute. Common symptoms include:

Hand clumsiness — difficulty with fine motor tasks such as buttoning shirts, writing, typing, or handling small objects; often one of the earliest symptoms
Grip weakness — difficulty opening jars, holding objects, or maintaining grip strength
Arm numbness or tingling — may be diffuse rather than following a single nerve root distribution
Gait disturbance — unsteadiness, a wide-based or shuffling walk, difficulty with balance, or a feeling that the legs are “heavy” or not responding normally
Leg spasticity or weakness — stiffness, leg heaviness, or difficulty climbing stairs
Electric shock sensation with neck flexion — known as Lhermitte’s sign; a shooting electrical sensation down the spine or into the limbs when bending the neck forward
Bladder dysfunction — urgency, frequency, or in advanced cases, incontinence
Neck pain — present in many but not all patients; its absence does not rule out myelopathy

Many patients with cervical myelopathy are told their symptoms are due to carpal tunnel syndrome, peripheral neuropathy, multiple sclerosis, or simply getting older. If you have been evaluated for these conditions without a clear diagnosis, cervical myelopathy should be considered. An MRI of the cervical spine is the key diagnostic study.

DIAGNOSIS & EVALUATION

At the initial consultation, Dr. Sardar performs a comprehensive neurological examination specifically designed to identify the signs of myelopathy — including testing of reflexes, balance, coordination, and fine motor function. He then reviews all available imaging in detail. The evaluation typically includes:

MRI of the cervical spine — the primary study; shows the degree of cord compression and any signal change within the cord (myelomalacia), which reflects cord injury and informs prognosis
CT scan — used to assess bony anatomy, the degree of stenosis, and the presence of ossification (OPLL); critical for surgical planning
Standing cervical X-rays with flexion-extension views — to assess cervical alignment, lordosis, and dynamic instability
Electromyography (EMG) / nerve conduction studies — occasionally used to differentiate myelopathy from peripheral neuropathy or other conditions

Severity of myelopathy is graded using standardized scales including the modified Japanese Orthopaedic Association (mJOA) score and the Nurick grade. These scores help quantify functional impairment, guide surgical decision-making, and track recovery over time.

WHEN IS SURGERY NEEDED?

Unlike many spinal conditions where conservative treatment is the appropriate first step, cervical myelopathy is different. Once the diagnosis of moderate or severe myelopathy is established, surgery is generally recommended without prolonged delay. The reasons are straightforward:

Myelopathy does not reliably improve with physical therapy, injections, or medications — these do not decompress the spinal cord
Neurological function that is lost to myelopathy may not be recoverable after prolonged compression
Many patients experience a slow, stepwise decline punctuated by episodes of sudden worsening — often triggered by minor trauma or neck movement
Surgery is most effective when performed before significant cord signal change (myelomalacia) has developed on MRI

For patients with mild myelopathy, close observation with periodic MRI may be appropriate in selected cases. For moderate to severe myelopathy, or for patients with progressive symptoms, surgery is the standard of care.

SURGICAL OPTIONS

The choice of surgical approach for cervical myelopathy depends on the number of levels involved, the location of compression (anterior, posterior, or both), the patient’s cervical alignment, and individual anatomical factors. Dr. Sardar performs the full range of cervical decompression procedures.

Anterior Cervical Discectomy and Fusion (ACDF)

ACDF is the most common surgical treatment for cervical myelopathy caused by disc herniation or anterior compression at one to three levels. Through a small incision on the front of the neck, the disc is removed, the cord and nerve roots are decompressed, and the disc space is reconstructed with a spacer and bone graft and stabilized with a plate and screws. ACDF reliably achieves decompression, has a high fusion rate, and is associated with excellent outcomes for appropriately selected patients.

Cervical Disc Replacement (Arthroplasty)

For selected patients with myelopathy caused by disc herniation at one or two levels, cervical disc replacement offers an alternative to fusion. The disc is removed and replaced with an artificial disc implant that preserves motion at the treated level. This approach avoids the stiffness associated with fusion and may reduce the risk of adjacent segment degeneration over time. Dr. Sardar is an expert in cervical disc replacement and will discuss whether it is an appropriate option for your specific anatomy and imaging findings.

Anterior Cervical Corpectomy and Fusion (ACCF)

When compression extends behind the vertebral body itself — such as in OPLL or multilevel spondylosis — the vertebral body may need to be removed (corpectomy) to fully decompress the cord. The resulting defect is reconstructed with a cage or strut graft and stabilized with a plate. ACCF provides wide anterior decompression for cases where ACDF alone is insufficient.

Laminoplasty

Laminoplasty is a posterior procedure that decompresses the spinal cord by expanding the spinal canal without removing the laminae entirely. The laminae are hinged open and held in an expanded position with small plates, creating more room for the cord while preserving the posterior structures. Laminoplasty is well-suited for multilevel compression (typically three or more levels) in patients with preserved cervical lordosis, and it avoids the need for fusion, maintaining some neck mobility.

Laminectomy with Posterior Cervical Fusion

When multilevel decompression is needed in a patient with cervical kyphosis or instability, laminectomy (removal of the laminae) combined with posterior instrumented fusion provides both decompression and stabilization. This approach prevents the progressive kyphotic deformity that can occur after laminectomy alone in patients with compromised cervical alignment.

WHAT TO EXPECT: SURGERY & RECOVERY

Recovery from cervical myelopathy surgery depends on the severity of cord compression before surgery, the presence of cord signal change on MRI, and the procedure performed. Most patients notice an improvement in their symptoms within weeks to months of surgery, though full neurological recovery can take up to a year or longer.

Hospital stay: 1–2 days for anterior procedures; 2–3 days for posterior procedures.
Return to light activity: 2–4 weeks.
Return to work: Sedentary roles typically within 2–4 weeks; physical roles 6–12 weeks depending on the procedure.
Neurological recovery: Hand function and fine motor skills often improve first; gait and balance improvements may follow over months. The goal of surgery is to halt progression and allow recovery — the extent of recovery depends on the severity and duration of cord compression before surgery.
Driving and neck precautions: Specific instructions are reviewed at the pre-operative visit and vary by procedure.

Dr. Sardar uses intraoperative neuromonitoring for all cervical myelopathy procedures, providing real-time information about spinal cord and nerve root function throughout the case. He personally follows every patient through all post-operative appointments.

FREQUENTLY ASKED QUESTIONS

Can cervical myelopathy get better on its own?

Rarely. The natural history of cervical myelopathy is one of slow, stepwise deterioration for most patients. Some patients remain stable for extended periods, but spontaneous improvement is uncommon. The risk of sudden neurological worsening after a minor injury or neck hyperextension — even a fall or a car accident — is a particular concern in patients with significant cord compression. Waiting too long before surgery risks irreversible cord damage.

How do I know if my symptoms are from myelopathy or a pinched nerve?

A pinched nerve (radiculopathy) typically causes pain, numbness, or weakness that follows a specific nerve root distribution — for example, pain radiating down one arm in a specific pattern. Myelopathy produces a different set of symptoms: hand clumsiness, gait problems, leg spasticity, and bladder changes that are broader and less focal. Many patients have both simultaneously. An MRI and a thorough neurological examination will clarify which is present and to what degree.

Will surgery restore my hand function and walking?

Surgery stops the compression and gives the spinal cord the best environment to recover. Most patients experience meaningful improvement, particularly when surgery is performed before severe cord signal change has developed. The degree of recovery depends on how long the cord has been compressed, how severe the compression is, and whether irreversible cord injury (myelomalacia) is already present on MRI. Dr. Sardar will give you a frank assessment of your prognosis based on your specific imaging and examination findings.

What happens if I don’t have surgery?

For patients with moderate or severe myelopathy, continued observation without surgery risks progressive neurological decline. Physical therapy and pain management do not decompress the spinal cord. A minor trauma — a fall, a car accident, or even forceful neck movement — can cause sudden, severe neurological deterioration in a patient with significant cord compression. This is why timely surgical intervention is generally recommended once moderate myelopathy is diagnosed.

Is cervical myelopathy surgery dangerous?

Cervical myelopathy surgery at high-volume centers by experienced surgeons has an excellent safety profile. Serious neurological complications are rare. Dr. Sardar uses intraoperative neuromonitoring throughout all cervical procedures, providing real-time feedback on spinal cord and nerve root function. A detailed discussion of your specific risks and benefits is a central part of every pre-operative consultation.

WHY CHOOSE DR. SARDAR FOR CERVICAL MYELOPATHY

Cervical myelopathy surgery requires a surgeon with expertise across the full range of anterior and posterior cervical approaches, the judgment to match the right procedure to each patient’s anatomy and alignment, and the experience to manage the most complex presentations including OPLL, cervical deformity, and revision cases.

Dr. Sardar trained across three fellowship programs spanning orthopedic and neurosurgical spine surgery, cervical disc replacement, and complex spinal deformity — giving him a uniquely comprehensive technical foundation for cervical spine surgery. As a cervical spine specialist and Co-Chief of Spinal Deformity Surgery at the Och Spine Hospital at NewYork-Presbyterian, he manages the full spectrum of cervical pathology, from straightforward ACDF to complex multilevel reconstruction and revision surgery.

He is an expert in cervical disc replacement and will always discuss whether a motion-preserving option is appropriate before recommending fusion. Intraoperative neuromonitoring is used as standard for all cervical myelopathy procedures.

Patients travel from across the United States and internationally to see Dr. Sardar for cervical myelopathy. Telemedicine consultations are available for patients in NY, NJ, CT, FL, PA, MO, CA, and TX. International patients can contact NewYork-Presbyterian Global Services at +1-212-746-9100.

This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition and treatment options.