Degenerative disease of the cervical spine (destruction of intervertebral disk, spondylosis and spondylarthrosis) affect a significant percentage of the population, in the fifth decade it can be demonstrated approximately in half of the patients examined. It also represents the most common cause of clinically manifest spine disease (up to 32% of myelopathies are claimed to be of spondylotic origin). There are differing views on treatment of cervical spondylotic myelopathy (CSM) regarding indication criteria and mode of surgical treatment. The studies published to date most often suffer inhomogeneity of the patient group, overload with a multitude of investigated parameters and the evaluation is typically retrospective. In the current work, the authors attempted to select out of a relatively small set of patients a single group, which would benefit from aggressive surgical decompression (corpectomy) and proposed a detailed examination protocol. The authors evaluate in a prospective study a group of 21 surgically treated patients with stenosis of the cervical spine and clinically and electrophysiologically demonstrated myelopathy. The original criterion to limit the study only to the patients with no spinal root involvement was abandoned for a very small number of such patients and the study was progressively extended to include patients with radiculopathy in addition to myelopathy. The surgical procedure was always a single- or multi-level somatectomy (corpectomy), desis with tricortical graft and fixation with titanium implants (splint with unicortical, secured screws).Within the patient group, two different subgroups can be delimited: 1. a less homogeneous group of patients with a chronic form of CSM (mostly with many year history of the disease), with stable or slowly progressing course, in whom a radical surgical decompression and stabilization brought a small or no effect. 2. patients with myelopathy of sudden origin or sudden progression, with clear imaging finding of spine compression, in whom the decompression had a marked and rapid effect. Both groups are difficult to separate, there are gradual transitions from one to the other. The available clinical, electrophysiological and imaging findings do not always uncover the cause of the myelopathy, spondylotic myelopathy cannot be reliably separated from a co-occurrence of myelopathy of different origin on the background of degenerative disease of the cervical spine. The selected surgical procedure is markedly invasive, accompanied with a risk of post-operative radicular paralysis and should only be used in patients of group 2, after thorough consideration of all clinical and para-clinical criteria.

        Key words: Chiari malformation, syringomyelia, decompression of craniocervical junction, neocisterna magna, dural plasty