Nonoperative Management of Cervical Myelopathy

John M. Rhee, Mohammed F. Shamji, W. Mark Erwin, Richard J. Bransford, S. Tim Yoon, Justin S. Smith, Han Jo Kim, Claire G. Ely, Joseph R. Dettori, Alpesh A. Patel, Sukhvinder Kalsi-Ryan
2013 Spine  
CRD summary This review compared the safety and effectiveness of non-operative treatment, with those of surgery, and assessed the risk of neurological deterioration for patients with cervical myelopathy or asymptomatic cord compression. There was a lack of high-quality evidence to support non-surgical treatment. There was potential for bias in the review, but the authors' conclusions seem appropriate. Authors' objectives To assess the safety and effectiveness of non-surgical treatment for
more » ... ts with cervical myelopathy, and to assess the risk of neurological deterioration, due to some activities or mild trauma, in patients with asymptomatic cord compression. Practice: The authors stated that they did not recommend the routine prescription of non-surgical treatment for patients with moderate-to-severe myelopathy. They recommended that if it was considered, care should be taken to monitor for neurological deterioration. They also recommended that patients should be counselled about the uncertainties around minor trauma as a risk factor for neurologic deterioration. Research: The authors stated that further studies, preferably randomised controlled trials, were needed to clarify the role of non-operative treatment, particularly for patients with milder myelopathy. Studies were needed to compare the safety, cost, mortality, neurologic progression, and complications associated with non-operative treatment and surgery.
doi:10.1097/brs.0b013e3182a7f41d pmid:23963006 fatcat:xxtkg7ep75gthi43slcf3klcxy