Anterior cervical surgery for the treatment of cervical degenerative myelopathy

被引：38

作者：

Matz, Paul G. ^{[1
]}

Holly, Langston T. ^{[2
]}

Mummaneni, Praveen V. ^{[3
]}

Anderson, Paul A. ^{[4
]}

Groff, Michael W. ^{[6
,7
]}

Heary, Robert F. ^{[8
]}

Kaiser, Michael G. ^{[9
]}

Ryken, Timothy C. ^{[10
]}

Choudhri, Tanvir F. ^{[11
]}

Vresilovic, Edward J. ^{[12
]}

Resnick, Daniel K. ^{[5
]}

机构：

[1] Univ Alabama, Div Neurol Surg, Birmingham, AL USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Div Neurosurg, Los Angeles, CA 90095 USA

[3] Univ Calif San Francisco, Dept Neurosurg, San Francisco, CA 94143 USA

[4] Univ Wisconsin, Dept Orthopaed Surg, Madison, WI USA

[5] Univ Wisconsin, Dept Neurol Surg, Madison, WI USA

[6] Harvard Univ, Sch Med, Dept Neurosurg, Boston, MA USA

[7] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[8] Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Neurosurg, Newark, NJ 07103 USA

[9] Columbia Univ, Neurol Inst, Dept Neurol Surg, New York, NY USA

[10] Univ Iowa Hosp & Clin, Dept Neurosurg, Iowa City, IA 52242 USA

[11] Mt Sinai Sch Med, Dept Neurosurg, New York, NY USA

[12] Penn State Coll Med, Dept Orthopaed Surg, Milton S Hershey Med Ctr, Hershey, PA USA

来源：

JOURNAL OF NEUROSURGERY-SPINE | 2009年 / 11卷 / 02期

关键词：

cervical spine; cervical spondylosis; discectomy; corpectomy; practice guidelines; treatment outcome;

D O I：

10.3171/2009.3.SPINE08724

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Object. The objective of this systematic review was to use evidence-based medicine to examine the efficacy of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM). Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to anterior cervical surgery and CSM. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Mild CSM (modified Japanese Orthopaedic Association [mJOA] scale scores > 12) responds in the short term (3 years) to either surgical decompression or nonoperative therapy (prolonged immobilization in a stiff cervical collar, "low-risk" activity modification or bed rest, and antiinflammatory medications) (Class II). More severe CSM responds to surgical decompression with benefits being maintained a minimum of 5 years and as long as 15 years postoperatively (Class III). Conclusions. Treatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score <= 12) should be considered for surgery depending upon the individual case. The shortcomings of this systematic review are that the group was not able to determine whether an mJOA scale score of 12 was indicative of a more severe CSM disease course, and whether patients who received nonsurgical treatment for 3 years had a significant probability for clinical deterioration after that time point. (DOI: 10.3171/2009.3.SPINE08724)

引用

页码：170 / 173

页数：4

共 7 条

[1] The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy -: Prospective randomized study [J].