الفهرس 
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Abstract
Cervical spondylosis is a chronic degenerative disorder that affects the cervical spine concerning the intervertebral discs, the vertebral bodies, facet joints, longitudinal ligaments, and ligamentum flavum [1].
The spondylotic process progresses with age and often involves multiple vertebral levels [2].
Cervical spondylotic myelopathy is a spinal cord dysfunction in the neck due to degenerative factors with slow insidious onset presenting with variable symptoms and signs in the adult population [3].
The repeated injuries to the spinal cord, which result in cervical spondylotic myelopathy, are caused by both static and dynamic factors [4].
The phenomenon of cervical canal stenosis is “dynamic” in nature and local spinal instability plays a major role in its pathogenesis [38].
The disease is insidious and the variable symptoms and signs have been proven not to be pathognomonic. Spastic gait is a common presentation and even bowel and bladder dysfunction may also be present. The signs include spasticity, hyperreflexia, Babinski sign and clonus [6, 9].
MRI remains the most useful diagnostic tool. It also provides an evaluation of the spinal cord, ligaments, and the intervertebral discs, MRI help to exclude and rule out other differential diagnoses like tumors [10].
The primary treatment of cervical spondylotic myelopathy (CSM) is to decompress the spinal cord directly e.g. by laminectomy and indirectly by fusion [87, 88].
SUMMARY
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The surgeon may perform surgery from the front of the neck, which is called an anterior approach. In other situations, the surgeon may perform surgery from the back of the neck, which is called a posterior approach [45].
Multiple modalities of surgical techniques have been recommended, but none has been uniformly accepted or is considered to be the ideal or the “gold standard” [59].
Cervical laminectomy has been utilized for the treatment of multilevel cervical spondylosis. It provides adequate decompression of the cervical spinal cord and is easily performed [12].
In 2010, Goel et al presented a new surgical modality using the transarticular facet fixation and fusion operation without laminectomy as a simple, short, safe and sufficient alternative surgery depending upon his philosophy about the role of facet instability, hypermobility and telescoping as the main factor of the vicious cycle of the cervical spondylosis [13].
Cervical spondylotic myelopathy is universally believed to be caused by both dynamic and static factors. All efforts have been directed toward elimination of the static factors like discs and disc-osteophyte complexes. Even the added fixation and eventually fusion is just complementary to the resection procedures to prevent the expected postoperative instability and to fix the graft in place in certain procedures [3].
Ajiboye et al concluded that patients with cervical spondylotic myelopathy that underwent a posterior surgical fusion are associated with a regression in disc-osteophyte complex size compared to non-fusion posterior procedures. This is most likely related to the loss of mobility of the cervical spine after the operation as governed by the Heuter-Volkmann’s principle and Wolff’s law. Although the decompressive effect of laminectomy and laminoplasty is primarily owned to the posterior drift of the spinal cord away from anterior compressive factors, disc-osteophyte complexes regression and reversal provide another mechanism of spinal cord decompression [87, 88].