A new dimension in degenerative cervical myelopathy

Development of spinal instrumentation enabled the use of fusion techniques along with decompressive surgery to prevent motion of cervical elements and maintain the cervical spine shape; however, it has not resulted in a clinically relevant change in outcomes.4 Data have been published on surgical techniques, approaches, and implants to improve the treatment of spinal degenerative disorders, with some substantial differences shown, but none described a clinically relevant result leading to changes in practice. Riluzole has neuroprotective properties, is approved by the US Food and Drug Administration for amyotrophic lateral sclerosis,5 and has been investigated in other spinal cord injuries using animal models,6 making it an attractive option. The concepts of preconditioning, applying a stressful but sublethal stimulus before the lethal event (causing definite damage) to stimulate metabolism and increase tolerance,7 or postconditioning, repeatedly inducing a sublethal event after the insult to suppress inflammatory responses and promote neurogenesis,8 could be good starting points for future research.