Posterior cervical expansive open-door laminoplasty (also known as unilateral open-door laminoplasty) is a surgical technique used to decompress the spinal cord in cervical myelopathy or spinal cord injury. The procedure involves a midline posterior cervical incision, followed by exposure of the laminae. A high-speed burr is used to create a hinged trough on one side (preserving the inner cortex) and a complete trough on the contralateral side, allowing the lamina to be gently elevated like an opening door. The opened lamina is then stabilized using sutures, miniplates, or spacers to maintain the expanded canal diameter. This approach effectively increases spinal canal space while preserving posterior elements, reducing cord compression while minimizing instability risks compared to laminectomy. It is particularly indicated for multilevel cervical stenosis with preserved cervical alignment.

Posterior lumbar discectomy with fusion (PLDF) is a standard surgical treatment for lumbar disc herniation with instability or recurrent symptoms. The procedure involves a midline posterior approach to expose the affected vertebral level, followed by laminotomy or partial laminectomy to access the neural elements. The herniated disc material is carefully removed to decompress the nerve roots, after which pedicle screws and rods are inserted for segmental stabilization. Interbody fusion (via posterior lumbar interbody fusion [PLIF] or transforaminal lumbar interbody fusion [TLIF]) is often performed by placing a bone graft or cage in the disc space to promote bony union. The combination of neural decompression, rigid instrumentation, and interbody fusion aims to relieve radicular pain while restoring spinal stability and alignment.

Surgical resection of spinal tumors involves a tailored approach based on tumor location, type (primary/metastatic), and spinal stability. For posteriorly accessible lesions, a midline incision exposes the affected vertebrae, followed by laminectomy to access the epidural space and decompress neural elements. Tumor resection is performed using meticulous dissection, with intraoperative neuromonitoring to minimize neurological risk. In cases requiring vertebral body involvement, a posterolateral (costotransversectomy) or combined anterior-posterior approach may be used for en bloc or piecemeal excision. Reconstruction typically involves spinal instrumentation (pedicle screws/rods) and structural support (cages/allografts) to restore stability. The goal is maximal safe resection while preserving neurological function, often supplemented by adjuvant therapies (radiation/chemotherapy) for malignant tumors.

Conservative management of ankylosing spondylitis (AS) focuses on symptom relief, functional preservation, and slowing disease progression through a multidisciplinary approach. First-line pharmacotherapy includes NSAIDs (e.g., celecoxib) for pain and inflammation control, supplemented by TNF-α inhibitors (e.g., adalimumab) or IL-17 inhibitors for refractory cases. Physical therapy emphasizes daily spinal extension exercises, postural training, and deep breathing to maintain mobility and prevent kyphotic deformity. Patient education on ergonomic adjustments (sleeping positions, workplace modifications) and low-impact aerobic exercise (swimming, yoga) is integral. Smoking cessation is strongly advocated due to its association with worse outcomes. Regular monitoring with inflammatory markers (CRP/ESR) and imaging (MRI for early sacroiliitis) guides therapeutic adjustments, while comorbidities (uveitis, osteoporosis) require coordinated care.

Surgical management of cervical spondylotic myelopathy (CSM) aims to decompress the spinal cord and stabilize the spine, with the approach tailored to pathology and spinal alignment. For multilevel anterior compression, anterior cervical discectomy/fusion (ACDF) or corpectomy with plating is preferred, utilizing structural grafts or cages to restore lordosis. Posterior approaches (laminoplasty or laminectomy with fusion) are indicated for multilevel stenosis with preserved cervical curvature, employing lateral mass or pedicle screws for fixation. Hybrid strategies (e.g., ACDF combined with laminoplasty) address complex cases. Intraoperative neuromonitoring (SSEPs/MEPs) minimizes neurological risks, while emerging techniques like cervical disc arthroplasty are considered in select patients to preserve motion. Surgical timing is critical, with earlier intervention correlating to better neurological recovery in progressive myelopathy.

Surgical management of cervical spondylotic myelopathy (CSM) aims to decompress the spinal cord and stabilize the spine, with the approach tailored to pathology and spinal alignment. For multilevel anterior compression, anterior cervical discectomy/fusion (ACDF) or corpectomy with plating is preferred, utilizing structural grafts or cages to restore lordosis. Posterior approaches (laminoplasty or laminectomy with fusion) are indicated for multilevel stenosis with preserved cervical curvature, employing lateral mass or pedicle screws for fixation. Hybrid strategies (e.g., ACDF combined with laminoplasty) address complex cases. Intraoperative neuromonitoring (SSEPs/MEPs) minimizes neurological risks, while emerging techniques like cervical disc arthroplasty are considered in select patients to preserve motion. Surgical timing is critical, with earlier intervention correlating to better neurological recovery in progressive myelopathy.

Conservative management of lumbar spinal stenosis (LSS) focuses on symptom alleviation and functional improvement through a multimodal approach. First-line interventions include NSAIDs or acetaminophen for neurogenic claudication pain, with consideration of epidural steroid injections for refractory radicular symptoms. Supervised physical therapy emphasizes flexion-based exercises, core stabilization, and aquatic therapy to reduce mechanical stress on neural structures. Activity modification strategies (e.g., avoiding prolonged standing) combined with assistive devices (walking frames) improve mobility. Adjuvant therapies such as gabapentinoids may be trialed for neuropathic pain, while cardiovascular conditioning (stationary cycling) counters deconditioning. Patient education on weight management and posture optimization is integral, with surgical evaluation reserved for progressive neurological deficits or failure of 3-6 months structured conservative care.

Surgical intervention for caudal plexus disorders is indicated in cases of structural compression, trauma, or refractory symptoms unresponsive to conservative measures. The approach involves meticulous exposure of the lumbosacral plexus through a retroperitoneal or transabdominal route, depending on lesion location. For compressive pathologies, microsurgical decompression with intraoperative neurophysiological monitoring (IONM) is performed to minimize iatrogenic injury. In traumatic avulsions or sharp injuries, direct nerve repair, grafting, or neurolysis may be attempted to restore function. For chronic pain syndromes, dorsal root entry zone (DREZ) ablation or nerve decompression may be considered. Surgical success depends on etiology, timing of intervention, and extent of neural damage, with optimal outcomes achieved in early decompression of compressive lesions or precise repair of focal injuries.

The TPR-a validated radiographic marker for developmental spinal canal stenosis-was derived by dividing mid-sagittal spinal canal diameter by corresponding vertebral body diameter on neutral lateral radiographs, measured via calibrated digital calipers.

Intramedullary hyperintensity was quantified using mid-sagittal T2-weighted MRI: circular regions of interest (ROIs, 0.05 cm²) were delineated at sites of maximal cord hyperintensity, with reference ROIs (0.3 cm²) sampled at C7-T1 (Figure 2). The SIR was calculated as mean pathological ROI intensity divided by mean reference ROI intensity; SIR ≥1.32 defined HCS, indicative of edema, hemorrhage or liquefaction.

Spinal cord compression rate was computed from axial T2-MRI measurements as [(uncompressed anteroposterior spinal cord diameter - maximal compressed diameter)/uncompressed diameter] × 100% (Figure 3), with ≥20% denoting significant compression.