Treating multilevel (three or four level) cervical myelopathy with ACDF or ACCF

The purpose of this article is to review the pathogenesis, presentation, natural history, and treatment options for multilevel cervical spondylotic myelopathy (CSM). CSM is a common, disabling, and progressive disease in the adult population. Symptomatic and progressive CSM is best treated surgically. Surgical options include anterior, posterior, and combined approaches. ACDF, ACCF, and posterior surgery are all effective surgical techniques for treating multilevel CSM. The choice of surgery depends on several factors including the sagittal alignment, location of the compressive lesion, presence of preoperative neck pain, and longitudinal extent of the compression.