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Cervical Spondylotic Myelopathy: Current State of the Art and Future Directions

Fehlings, Michael G. MD, PhD, FRCSC*; Tetreault, Lindsay A. HBSc*; Wilson, Jefferson R. MD; Skelly, Andrea C. PhD, MPH

doi: 10.1097/BRS.0b013e3182a7e9e0

Study Design. Narrative overview of the focus issue on cervical spondylotic myelopathy (CSM).

Objective. To provide an introduction to this special focus issue of Spine journal that deals with CSM.

Summary of Background Data. CSM is a progressive spine disease and the leading cause of spinal cord dysfunction worldwide. The shift in population demographics in many parts of the world has motivated the development of this focus issue. With the overall aging of the population, we can predict that global health care systems will be confronted with an increase in patients presenting with degenerative spine changes and various stages of cervical myelopathy.

Methods. The articles in this issue vary in their methods—there are systematic reviews, narrative reviews, a study protocol, and 2 primary research articles.

Results. A summary of the findings of each article is provided as a table within this introduction.

Conclusion. By way of this issue, we have summarized current knowledge gaps and limitations in the evidence to provide direction for future research and investigation. These include the need for a unified nomenclature for referring to CSM, the need to specify the incidence of myelopathy and the prevalence of ossification of the posterior longitudinal ligament, and the need to explore both the safety and efficacy of neuroprotective and neuroreparative pharmacological strategies. Further work is also required to optimize the management of patients with minimal symptoms.

This introduction to the Spine focus issue on cervical spondylotic myelopathy summarizes the reason for the issue and the findings of the articles.

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

Department of Surgery, Divisions of Neurosurgery and Orthopedic Surgery, Spinal Program, University of Toronto, Toronto, Ontario; and

Evidence-Based Practice Division, Spectrum Research, Inc., Tacoma, WA.

Address correspondence and reprint requests to Michael G. Fehlings, MD, PhD, FRCSC, Toronto Western Hospital, University Health Network, Room 4W-449, 399 Bathurst St, Toronto, Ontario M5T 2S8; E-mail:

Acknowledgment date: June 18, 2013. First revision date: July 23, 2013. Acceptance date: August 2, 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: support for travel, fees for participation in review activities, and payment for writing or reviewing the manuscript.

© 2013 by Lippincott Williams & Wilkins