Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years

Kada?ka Z, Bedna?ík J, Novotný O, Urbánek I, Dušek L.

Eur Spine J. 2011 Sep;20(9):1533-8. Epub 2011 Apr 26.

Department of Neurology, Masaryk University and University Hospital Brno, Jihlavská 20, 63900 Brno, Czech Republic

• 64 patients with non progressive or slowly progressive mild and moderate cervical spondylotic myelopathy(CSM), were randomized to receive either conservative or surgical treatment.
• The treatment of mild to moderate cervical spondylotic myelopathy  remains a management uncertainity.
• Although it appears logical to remove the spondylotic compression of the spinal cord, evidence is still lacking as to the benefits and risks of surgical decompression.
• The aim of this randomized controlled trial is to evaluate the effectiveness of surgical decompression in CSM.

Principal Research Question:

• Does surgical treatment for patients with non progressive or slowly progressive CSM lead to superior neurological functional outcomes in comparison to conservative treatment?

Population: 64patients with non progressing or slowly progressing mild and moderate CSM. 32 patients were managed surgically and 32 patients were treated conservatively.

Intervention: Surgical, unclear from the study. Conservative approach, unclear from the study.

Outcomes: Japanese Orthopaedic Association, as modified by Benzel, subjective clinical outcomes

Time: Upto 10 years

Findings:

• no significant difference in relation to neurological function
• 17 deaths occurred, but none were related to surgery
• Power analysis found that surgical intervention was not superior to conservative approach

Due to the limited nature of this study, further clinical trials need to be conducted before any statement can be made.

Ref:

http://www.myorthoevidence.com/