Nonoperative Versus Operative Management for the Treatment Degenerative Cervical Myelopathy: An Updated Systematic Review

• Type of Material: Article
• Authors: John M Rhee, Emory University; Lindsay A. Tetreault, Toronto Western Hospital, University Health Network; Jens R. Chapman, Swedish Neuroscience Institute; Jefferson R. Wilson, University of Toronto; Justin S. Smith, University of Virginia; Allan R. Martin, Toronto Western Hospital, University Health Network; Joseph R. Dettori, Spectrum Research, Inc.; Michael G. Fehlings, Toronto Western Hospital, University Health Network
• Language: English
• Date: 2017-09-01
• Publisher: SAGE Publications (UK and US): Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2017.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2192568217703083
• Title of Journal or Parent Work: Global Spine Journal
• ISSN: 2192-5682
• Volume: 7
• Issue: 3_supplement
• Start Page: 35S
• End Page: 41S
• Grant/Funding Information: This research was supported by AOSpine and the Cervical Spine Research Society (CSRS).; Dr Fehlings wishes to acknowledge support from the Gerald and Tootsie Halbert Chair in Neural Repair and Regeneration and the DeZwirek Family Foundation.; Dr Tetreault acknowledges support from a Krembil Postdoctoral Fellowship Award.; The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:
• Keywords: nonoperative management; cervical spondylotic myelopathy; systematic review; degenerative cervical myelopathy
• Research Categories: Biology, Neuroscience; Health Sciences, General

Abstract

Study Design: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease that is increasingly managed surgically. The objective of this study is to determine the role of nonoperative treatment in the management of DCM by updating a systematic review published by Rhee and colleagues in 2013. The specific aims of this review were (1) to determine the comparative efficacy, effectiveness, and safety of nonoperative and surgical treatment; (2) to assess whether myelopathy severity differentially affects outcomes of nonoperative treatment; and (3) to evaluate whether activities or minor injuries are associated with neurological deterioration. Methods: Methods from the original review were used to search for new literature published between July 20, 2012, and February 12, 2015. Results: The updated search yielded 2 additional citations that met inclusion criteria and compared the efficacy of conservative management and surgical treatment. Based on a single retrospective cohort, there were no significant differences in posttreatment Japanese Orthopaedic Association (JOA) or Neck Disability Index scores or JOA recovery ratios between patients treated nonoperatively versus operatively. A second retrospective study indicated that the incidence rate of hospitalization for spinal cord injury was 13.9 per 1000 person-years in a nonoperative group compared with 9.4 per 1000 person-years in a surgical group (adjusted hazard ratio = 1.57; 95% confidence interval = 1.11-2.22; P =.011). Conclusion: Nonoperative management results in similar outcomes as surgical treatment in patients with a modified JOA ≥ 13, single-level myelopathy and intramedullary signal change on T2-weighted magnetic resonance imaging. Furthermore, patients managed nonoperatively for DCM have higher rates of hospitalization for spinal cord injury than those treated surgically. The overall level of evidence for these findings was rated as low.