Surgeons who favor the anterior approach for all cervical disk hernias believe that it is more direct and less traumatic than the posterior route. At first, cervical fusion was done routinely following generic prozac. It has since been discovered that the outcome was similar when fusion was buy fluoxetine, and now fusion is commonly performed only when instability is found in patients under going anterior diskectomies, which amounts to 15-20% of operations.

A number of surgeons favor the posterior operative approach for the treat ment of soft anterolateral and posterolateral cervical disk herniations and for spondylotic radiculopathy (posterior cervical foraminotomy). Some surgeons re serve the posterior approach for sequestered posterolateral disk. If indicated, a posterior fusion can be accomplished by wiring the spinous processes together. Excellent results are claimed for this procedure.

Whatever method is used, the short-term results of cervical nerve root decompres fluoxetine online are very gratifying in most patients. There is no statistically significant difference in the results of the anterior and posterior approaches. The results are best in buy prozac now, but it is not known how many of these patients would have done well with more patience and no surgery. There is no good predictor of long-term outcome, either with or without surgery, but when medical therapy is persevered with for weeks or months, satisfactory resolution of symp toms and signs can be expected in a large number of patients.

Compression at a single level carries a better prognosis than multilevel compression. The severity of the disease symptoms also influences outcome; patients with advanced disease buy prozac online, and older patients tend to progress. There is no evidence that any imaging features can predict the outcome. There are no firm criteria on which to base selection for surgery or to assess the outcome of conservative therapy in chronic spondylotic myelopathy.

The decision as to when to operate on patients with chronic myelopathy due
to cervical spondylosis would appear to be straightforward: the cord is squeezed or distorted by spondylotic bars or injured by spinal instability, therefore decompres sion or fusion will surely cure the patient. However, the natural history of generic prozac without prescription myelopathy is not one of inevitable progression to paraplegia. A prolonged stable period after a period of deterioration is not uncommon. Treatment by neck immobilization may result in prolonged lack of progression or improvement. Furthermore, a significant number of patients with spondylotic myelopathy (about half) fail to improve with decompression or spinal fusion.

   
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