Posterior decompression for myelopathy due to cervical spondylosis: laminectomy alone versus laminectomy with dentate ligament section.

In summary we have reviewed some of the studies and theories regarding the role of the dentate ligaments in cervical spondylosis and myelopathy and the logic which has been proposed either for or against their transection in the surgical treatment of this disease. A review of our own series of patients shows no significant increased morbidity in patients undergoing decompressive laminectomy, dentate ligament section, and dural graft as compared to laminectomy alone for treatment of myelopathy due to cervical spondylosis. Of equal importance is the fact that we could demonstrate no superiority in terms of neurological benefit between these two types of operative therapy. However, intradural inspection carried out as a matter of routine did reveal unexpected midline disk protrusions in two cases, the removal of which allowed the patients to do better than might have been expected from laminectomy alone. These findings lead us to conclude that intradural exploration is always indicated if there exists any doubt as to the nature of the basic pathological process. Also there has been presented some experimental evidence to support division of the dentate ligaments if an unresectable anterior lying mass is found.