
Medically Reviewed By
Dr. Deepak Garg ( Orthopaedic Oncology & Robotic Joint Surgery)
A definitive spine surgery review on Cervical Spondylotic Myelopathy (CSM), detailing hyperreflexia, Hoffman/Babinski signs, gait spasticity, microscope-assisted decompression, ACDF cage fusion, and motion-preserving Cervical Artificial Disc Replacement.
CRITICAL CLINICAL RED FLAG: Clumsiness in hands (difficulty buttoning shirts, handwriting deterioration, dropping objects), a heavy stiff-legged spastic walking gait, or electric-shock sensations down the spine on neck flexion (Lhermitte's sign) indicates spinal cord compression requiring urgent surgical evaluation.
Cervical Spondylotic Myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults over 50. Degenerative disc height collapse, osteophytic ridge formation, and ligamentum flavum hypertrophy narrow the cervical spinal canal (<12 mm anteroposterior diameter). Dynamic repetitive neck flexion and extension generate shear stress and microvascular ischemia in the spinal cord.
Upper Motor Neuron Signs: Hyperreflexia, positive Hoffman reflex, clonus, and positive Babinski sign.
Loss of Manual Dexterity: Inability to perform rapid finger-to-thumb opposition within 10 seconds (10-second grip-and-release test).
The time-tested surgical benchmark for multi-level severe disc degeneration, kyphotic deformity, or facet arthrosis:
Smith-Robinson Approach: Safe blunt dissection along natural tissue planes between the trachea/esophagus and carotid sheath.
Microscopic Cord Decompression: Complete excision of herniated disc, posterior longitudinal ligament (PLL), and compressing osteophytes under 4K operative magnification.
Interbody PEEK/Titanium Cage: Packed with osteoinductive bone graft and secured with an anterior titanium cervical plate.
"Cervical disc arthroplasty preserves physiological neck motion and prevents adjacent segment disease, offering active patients a fast recovery without bone graft harvesting." — Dr. Deepak Garg

For single or two-level disease with preserved baseline motion and absence of severe facet arthritis, artificial disc replacement preserves segmental kinematics and reduces adjacent level strain from 25% down to <5%.
CLINICAL CAUTION: Delaying surgical decompression in moderate-to-severe cervical myelopathy leads to permanent, irreversible spinal cord gliosis (hyperintense T2 signal on MRI) and chronic quadriparesis.
Mobilization on Day 1 without rigid cervical collars in disc replacement patients, with return to non-contact sports and full driving at 4 to 6 weeks.
1. Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion: 10-Year Results of a Randomized Trial — J Bone Joint Surg Am, 2021; 103(17): 1570-1580.
2. A Global Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy — Global Spine J, 2017; 7(3_suppl): 70S-86S.

Senior Consultant & Clinical Director — Orthopaedic Oncology & Robotic Joint Surgery
MBBS (TNMC Mumbai), DNB Orthopaedics (PGI & SP Miraj), Fellowship Arthroplasty and Arthroscopy (Fortis Hospital, New Delhi), Fellowship Orthopaedic Oncology (Rajiv Gandhi Cancer Institute, New Delhi)

16+ Years Experience
Spica — Grover Hospital
Request a priority OPD appointment or second opinion on your scans.
Proprietary surgical methodologies and precision protocols pioneered by our senior directors to minimize trauma, protect natural anatomy, and accelerate recovery.

Dr. Deepak Garg (Orthopaedic Surgical Oncology - RGCI Delhi Trained) and Dr. Neha Gupta (Medical Oncology) co-lead the Bone Cancer & Sarcoma Center at Spica Healthcare. Integrating intensive multi-agent neoadjuvant chemotherapy protocols (MAP: High-Dose Methotrexate, Doxorubicin, Cisplatin for Osteosarcoma; VIDE: Vincristine, Ifosfamide, Doxorubicin, Etoposide for Ewing Sarcoma) with 3D computer-navigated limb salvage surgery and modular titanium megaprosthetic joint reconstruction, 5-year survival rates exceed 75% to 80% while saving over 95% of patients from limb amputation.
Spica Healthcare — Bone and Cancer Institute, Bathinda — is South-Western Punjab's premier super-speciality centre led by AIIMS and Tata Memorial fellowship-trained directors.
Every diagnostic MRI review, surgical staging, and operation is personally directed by chief clinical specialists — Dr. Deepak Garg (Orthopaedic Oncology & Robotics) and Dr. Neha Gupta (Medical Oncology) — guaranteeing zero junior proxies.
Sub-millimeter implant positioning and soft-tissue ligament balancing ensuring patients walk comfortably within 24 hours of total knee replacement.
South-West Punjab's only dedicated centre for modular titanium megaprosthesis, saving natural limbs and functions in 95%+ of bone cancer patients.
Full cashless coverage for Ayushman Bharat (PM-JAY), Punjab Govt Health Schemes, ECHS, and 30+ private insurance networks with on-desk approvals.
Positive-pressure HEPA filtered theatres minimizing infection rates below international benchmarks with 24/7 dedicated critical care backup.
Fellowship-trained surgical directors from AIIMS & Tata Memorial providing compassionate, world-class tertiary care in super-speciality orthopaedics and medical oncology.

Senior Consultant & Clinical Director — Medical Oncology
MBBS (BFUHS Faridkot), MD Radiation Oncology (BFUHS Faridkot), DrNB Medical Oncology (Sarvodaya Hospital, Faridabad), Precision Oncology (Harvard, USA), Ex Consultant RGCI New Delhi


Senior Consultant & Clinical Director — Orthopaedic Oncology & Robotic Joint Surgery
16+ Yrs ExpSenior Consultant & Clinical Director — Orthopaedic Oncology & Robotic Joint Surgery
MBBS (TNMC Mumbai), DNB Orthopaedics (PGI & SP Miraj), Fellowship Arthroplasty and Arthroscopy (Fortis Hospital, New Delhi), Fellowship Orthopaedic Oncology (Rajiv Gandhi Cancer Institute, New Delhi)
Free OPD screening camps, director-led masterclasses, and national oncology representations by Spica Healthcare.
Real stories from patients who recovered through limb preservation surgery, 3D robotic joint replacements, and precision cancer care at Spica Healthcare — Grover Hospital, Bathinda.
Evidence-based surgical recovery roadmaps, robotic joint protocols, and precision oncology insights written by our clinical directors.