Skip Navigation LinksHome > October 15, 2013 - Volume 38 - Issue 22S > Surgical Management of Degenerative Cervical Myelopathy: A C...
Spine:
doi: 10.1097/BRS.0b013e3182a7f4ff
Surgical Treatment of Cervical Spondylotic Myelopathy

Surgical Management of Degenerative Cervical Myelopathy: A Consensus Statement

Lawrence, Brandon D. MD*; Shamji, Mohammed F. MD; Traynelis, Vincent C. MD; Yoon, S. Tim MD§; Rhee, John M. MD§; Chapman, Jens R. MD; Brodke, Darrel S. MD*; Fehlings, Michael G. MD, PhD, FRCSC, FACS

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Abstract

Degenerative cervical myelopathy (DCM), including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, presents a heterogenous set of variables reflecting its complex nature. Multiple studies in the past have attempted to elucidate an ideal surgical algorithm that surgeons may use when treating these patients, unfortunately all studies to date, including the rigorous systematic review used in this focus issue, have fallen short in identifying a superior approach when addressing DCM. Likely because of a superior approach being nonexistent because there are multiple pathoanatomical considerations. In addition to the multitude of variables that spine surgeons face when deciding the treatment options for patients with DCM, the previous studies that have been published, unfortunately, lack in consistent outcome and complication reporting. Therefore, synthesizing a treatment algorithm remains difficult, however, the articles in this focus issue use the GRADE system to assess the overall quality (strength) of available evidence and, where appropriate, formulate evidence-based recommendations. Factors that should be included in surgical decision making are the sagittal alignment, anatomical location of the compressive pathology, number of levels of compression, presence of absence or instability or subluxation, the type compressive pathology (e.g., spondylosis vs. ossification of the posterior longitudinal ligament), neck anatomy, bone quality, and surgeon experience or preference. Fortunately, as reviewed in the accompanying articles, a number of excellent surgical options exist that can be selected on the basis of the aforementioned pathoanatomical considerations.

© 2013 by Lippincott Williams & Wilkins

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