Rob...
I see too many cases with conflicting opinions of surgeons. More traditional or more conservative is not always safer or better. Yesterday I was contacted by someone who wants info about Bradley... the 6-level cervical guy. It caused me to rekindle contacts and he's still doing great. EVERY other surgeon he went to told him that the not fusing his skull to his thoracic spine was nuts. We are not talking about surgeons in Podunk,,, we are talking about the best in the US.
Many will say that agressive application of technology is not safe... maybe they are right... maybe it's because they don't have any experience in that arena or cannot offer such options?
I don't remember enough about your case to comment, but I'd gather opinions and evaluate everything. These are tough decisions.
The numbers I've heard are that 1/3 of the patients with myelopathic symptoms will not get relief from decompressing the spinal cord.
Your question prompted me to contact my one client who had severe and long-standing myelopathic symptoms prior to his 2-level cervical ADR, now almost 2 years ago. He had waited too long with SEVERE gait problems for more than a year before his surgery. He was not in pain, so it was easy for him to wait. He considers the surgery a success even though he still has his severely altered gait. His symptoms did not get worse, although his gait did not improve. He still has no pain from his c-spine, but feels like he's not longer at risk of paralysis from a minor fall or auto accident. The cord compression is resolved, but unfortunately, the damage appears to be permanent. I'm not sure how this relates to your question except that in this one extreme case, there is no 'rebound myelopathy'.
I've seen increases in radicular symptoms in some cervical procedures, as we do in some lumbar procedures. I think that the incidence in cervical is lower and like lumbar, it almost always fades in a few days, weeks, or months. I've not seen increases in myelopathic symptoms in my clients, but the number of folks with real myelopathy has been low, so I don't know how relevant my experience is.
Remember all the "I'm not a doctor" diclaimer stuff... I'm just sharing my limited experience... take everything I say with a grain of salt, check it out and make your own decisions...
All the best.
Mark
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