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Study design:This is a case report.Objectives:Spinal cord atrophy presenting with late progressive myelopathy after many years of clinical stability is a rare and unexplained phenomenon after cervical spine surgery. The authors report and discuss the etiologies and outcomes of late postoperative myelomalacic myelopathy.Setting:This study was conducted in the Department of Neurosurgery, Centro Hospitalar S. João, Porto, Portugal.Methods:We report on two patients with insidious chronic progressive myelopathy that developed more than 10 years after complete removal of a cervical intramedullary ependymoma and after transoral odontoidectomy and occipitocervical fusion for craniocervical junction malformation. Differential diagnoses were formulated and review of the literature was performed.Results:In both patients, after several years of clinical stability, insidious onset of debilitating myelopathy and dependency ensued. The clinical history, serology, imaging and neurophysiological investigation excluded several putative etiologies: arachnoid adhesions, tumor recurrence, late vertebral instability, trauma, syringomyelia, radiotherapy, and demyelinating or infectious causes.Conclusion:Late neurological deterioration after cervical spine surgery is usually related to disease progression or surgery-related complications. Nevertheless, in some patients late myelopathy can ensue even in the absence of identified causes. [ABSTRACT FROM AUTHOR]