Use of instrumentation in degenerative disease of the cervical spine.

Degenerative diseases of the cervical spine (including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament) occur predominantly in elderly persons. Decompressive laminectomy has been the standard of surgical treatment in the United States for several decades. Postlaminectomy kyphosis and instability and inadequate decompression of anterior compressing forces can fail to halt and may even contribute to progression of neurologic deterioration. Instrumentation of the cervical spine provides a means of stabilization and allows safer multilevel anterior decompression. The biomechanics of degenerative disease of the cervical spine as well as surgical treatment options are discussed. Atlantoaxial transarticular screw fixation and other modalities of instrumentation are described.