Re-aggravation of myelopathy due to intramedullary lesion with spinal cord enlargement after posterior decompression for cervical spondylotic myelopthy: serial magnetic resonance evaluation. H Nagashima, Y Morio and R Teshima, Spinal Cord 2002; 40: 137–141.

Nagashima et al have addressed the possible causes for their patient with C3–4 spondylotic cord compression to have deteriorated postoperatively following initial clinical improvement. My review of their imaging studies reveals their patient to have been only decompressed from C3 to C7. It has been a consistent, basic tenet of neurosurgical technique to decompress at least one and preferably two levels above and below a site of cord compression. In this instance no decompression was afforded above C3 level. Had, at the very least, C2 also been decompressed, to my thinking it is unlikely that the patient's cervical cord would have been further impacted, and adversely affected, following his mobilization.