Symptomatic Progression of Cervical Myelopathy and the Role of Nonsurgical Management: A Consensus Statement

Fehlings, Michael G. MD, PhD, FRCS(C)*; Wilson, Jefferson R. MD*; Yoon, S. Tim MD, PhD; Rhee, John M. MD; Shamji, Mohammed F. MD, PhD*; Lawrence, Brandon D. MD

doi: 10.1097/BRS.0b013e3182a7f4de
Role of Non-Surgical Management in Cervical Spondylotic Myelopathy

This section of the cervical spondylotic myelopathy Spine focus issue collates the existing evidence related to natural history and nonoperative management. In the case of patients with symptomatic cervical spondylotic myelopathy treated nonoperatively, while 20% to 62% will deteriorate at 3 to 6 years of follow-up, no specific patient or disease characteristics have been shown to predict this change reliably. For patients without myelopathy with spondylotic cord compression, the rate of myelopathy development is approximately 8% at 1 year and approximately 23% at 4 years of follow-up. Clinical and/or electrophysiological evidence of cervical radiculopathy has been shown to predict such progression and should prompt strong consideration of surgical decompression. With respect to nonoperative care, in the case of mild myelopathy, there is low evidence that such treatment may have a role; for moderate and severe myelopathy, this treatment results in outcomes inferior to those of surgery and is not recommended. Given the unpredictably progressive nature of cervical myelopathy, the indications for nonoperative management are ostensibly limited. Finally, the preclinical rationale and clinical translation of a putative neuroprotective drug, which may one day serve to augment the effects of surgery in the treatment of cervical spondylotic myelopathy, is presented and discussed.

*University of Toronto, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

Emory University School of Medicine, Atlanta, GA; and

University of Utah; Salt Lake City, UT.

Address correspondence and reprint requests to Michael G. Fehlings, MD, PhD, FRCS(C), University of Toronto, Toronto Western Hospital, Ste. 4W449, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; E-mail:

Acknowledgment date: June 4, 2013. First revision date: July 12, 2013. Acceptance date: July 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America, Inc. Analytic support for this work was provided by Spectrum Research, Inc., with funding from the AOSpine North America.

Relevant financial activities outside the submitted work: consultancy, support for travel, board membership, grants/grants pending, fellowship support, patents, royalties, payment for lectures, payment for development of educational presentations, and stock/stock options.

© 2013 by Lippincott Williams & Wilkins