Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years

Abstract

It is not known whether the results of decompressive surgery to treat the mild and moderate forms of spondylotic cervical myelopathy (CSM) are any better than those of a conservative approach. A 10-year prospective randomised study was performed. The objective of the study was to compare conservative and operative treatments of mild and moderate, non-progressive, or slowly progressive, forms of CSM. Sixty-four patients were randomised into two groups of 32. Group A was treated conservatively while group B was treated surgically. The clinical outcome was evaluated by modified JOA score, timed 10-m walk, score of daily activities recorded by video and evaluated by two observers blinded to the type of therapy, and by subjective assessment by the patients themselves. Seventeen patents died of natural, unrelated causes, during the follow-up. A total of 25 patients in the conservatively and 22 in the surgically treated group were used for the final evaluation. There was no statistically significant difference between both groups in mJOA score, in subjective evaluation by the patients themselves and in evaluation of video-recordings of daily living activities by two observers blinded to treatment mode. There was neither any difference found in the percentage of patients losing the ability to walk nor in the time taken to cover the 10-m track from a standing start. Comparison of conservative and surgical treatment in mild and moderate forms of CSM in a 10-year follow-up has not shown, on average, a significant difference in results. In both groups, patients get better and worse. According to the power analysis it is necessary admit that these results possess the low ability to answer definitely the question which treatment is better for the patients with a mild and moderate non-progressive CSM because of the low number of patients for the final evaluation and for clinically negligible differences between two compared arms. These findings can serve as a worthy odds-on hypothesis which needs the confirmation.

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

“…13,14 Another prospective cohort study (n = 62) by Sampath et al reported the outcomes of nonoperative and surgical treatment of CSM and concluded that surgically treated patients had a significant improvement in functional status and overall pain. 28 However, the authors did not directly compare the 2 groups.…”

Surgery versus conservative care for neck pain: a systematic review

“…Three studies, of which two CCTs, compared surgery versus nonsurgical interventions in myelopathy patients [18,19,20]. The RCT also reported the 10-year follow-up data [21].…”

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy

“…The treatment of degenerative cervical spine disease has shown good clinical outcomes with rigid immobilization, physiotherapy, corpectomy/discectomy with and without fusion as well as with arthroplasty [27][28][29][30]. Fusion does accelerate radiological and clinical adjacent segment disease in the long-term as younger patients with fusion operated for traumatic spine injury seem to have these changes earlier [31].…”