Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives

Abstract

OBJECTIVECervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment.METHODSThe PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM.RESULTSA total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM.CONCLUSIONSThere is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.

Using Kano diagrams to display the most cited article types, affiliated countries, authors and MeSH terms on spinal surgery in recent 12 years

“…For instance, the US with a yellow bubble is the most influential country in the performance area on the bottom panel in Figure 1, providing a complemental interpretation of the choropleth map at the top panel in Figure 1. All figures provide QR-codes for interested readers to examine the details on the information with the dashboard on Google Maps, different from those regarding spine-related studies [37,38] using the world map only available in color online.…”

Letter to the Editor. Cervical spondylotic myelopathy

“…Cervical spondylotic myelopathy TO THE EDITOR: We read the article by Chen et al 1 with interest (Chen YC, Kuo CH, Cheng CM, et al: Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives. JNSPG 75th Anniversary Invited Review Article.…”

“…We agree with the importance of atlantoaxial fixation in the management of disorders of the craniovertebral junction. 1,4,9,10 For patients whose myelopathy is caused by a congenital or acquired anomaly that involves malalignment of vertebral segments, realignment and fixation by surgery certainly would work out perfectly. However, the current paper focused on CSM-myelopathy that is caused by cervical spondylosis, a progressive degenerative process affecting both the cervical vertebral bodies and intervertebral discs that frequently develops into a narrowing of the spinal canal.…”

Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system

“…Surgery is a widely accepted treatment for severe CSM with neurological complications. However, for asymptomatic or mildly symptomatic patients with CSM, the optimal management remains debated and surgery is sometimes controversial [4].…”