Once frank myelopathy occurs, surgical intervention is necessary. The primary goal of surgery is to decompress the spinal cord, thus giving the neural elements more room. Traditionally, cervical laminectomy, a posterior approach, has been used for surgical treatment of CSM. However, over the past 20 years, it has been increasingly recognized that laminectomy is not appropriate for all patients. Further neurologic deterioration after laminectomy is attributed to a development of latent instability of the spine with development of kyphotic spinal deformities and to the inability of posterior approaches to directly address anterior vector compression secondary to osteophytic overgrowth.
Approximately 11% of patients with spinal cord injuries meet the criteria for Major Depressive Disorder (MDD). Therefore, in patients with spinal cord injuries who show symptoms of depression, such as suicidal ideation, it is important to screen for major depression and consult for psychological care.
Bombardier et al found % of participants with spinal cord injuries met criteria for MDD. They found MDD was associated with poorer subjective health, lower satisfaction with life, and more difficulty in daily role functioning.
Kishi et al found that both acute and delayed-onset suicidal ideation was strongly associated with the existence of major depression and impaired social functioning in patients with spinal cord injury. They argue that the detection and appropriate treatment of depressive disorders and social isolation may be the most important factor in preventing suicide both during the acute and chronic period following spinal cord injuries.