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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

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


Research Funding:

he 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 also received funding from 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.


  • cervical spondylotic myelopathy
  • degenerative cervical myelopathy
  • nonoperative treatment
  • systematic review

Change in Function, Pain, and Quality of Life Following Structured Nonoperative Treatment in Patients With Degenerative Cervical Myelopathy: A Systematic Review

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Journal Title:

Global Spine Journal


Volume 7, Number 3_supplement


, Pages 42S-52S

Type of Work:

Article | Final Publisher PDF


Study Design: Systematic review. Objectives: The objective of this study was to conduct a systematic review to determine (1) change in function, pain, and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) variability of change in function, pain, and quality of life following different types of structured nonoperative treatment; (3) differences in outcomes observed between certain subgroups (eg, baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Methods: A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950, and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing, and/or traction. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results: Of the 570 retrieved citations, 8 met inclusion criteria and were summarized in this review. Based on our results, there is very low evidence to suggest that structured nonoperative treatment for DCM results in either a positive or negative change in function as evaluated by the Japanese Orthopaedic Association score. Conclusion: There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in function following structured nonoperative treatment. Furthermore, 23% to 54% of patients managed nonoperatively subsequently underwent surgical treatment.

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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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