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Author Notes:

Corresponding Author: Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada. Email: michael.fehlings@uhn.ca

In particular, we would like to thank Dr Bruce Darden (past president of the CSRS) for supporting this guideline initiative and Chi Lam, Kelly McCormick, and Nancy Holmes for their administrative assistance.

We would like to recognize Dr Jens Chapman who was instrumental in initiating this project and Dr Justin Smith who critically appraised our original protocol.

We would also like to acknowledge Dr Robert Inman, Dr David Choi, Dr Joseph Lee, and Dr Liang Zhang for their thorough external review.

Finally, we would like to thank Krystle Pagarigan and Eric Schnell from Spectrum Research, Inc, for their administrative support.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The guideline development group did not include a patient representative or a public member.

Committee positions: Co-Chair: Michael G. Fehlings, MD, PhD; Vice-Chair/Systematic Review Coordinator: Lindsay A. Tetreault, PhD; General Member of Leadership Group: Daniel Riew, MD; General Member of Leadership Group: James Middleton, MD; Co-Chair: Jeffrey C. Wang, MD.

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Research Funding:

The GDG would like to acknowledge the funding of AOSpine North America and the CSRS.

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:

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.

Methodological support was provided by Spectrum Research, Inc.

Keywords:

  • cervical spondylotic myelopathy
  • degenerative cervical myelopathy
  • guidelines
  • spinal cord compression

A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression

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Journal Title:

Global Spine Journal

Volume:

Volume 7, Number 3_supplement

Publisher:

, Pages 70S-83S

Type of Work:

Article | Final Publisher PDF

Abstract:

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

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© The Author(s) 2017

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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