• J Neurosurg Spine · Aug 2009

    Practice Guideline

    Anterior cervical surgery for the treatment of cervical degenerative myelopathy.

    • Paul G Matz, Langston T Holly, Praveen V Mummaneni, Paul A Anderson, Michael W Groff, Robert F Heary, Michael G Kaiser, Timothy C Ryken, Tanvir F Choudhri, Edward J Vresilovic, Daniel K Resnick, and Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.
    • Division of Neurological Surgery, University of Alabama, Birmingham, Alabama, USA. matzpg@yahoo.com
    • J Neurosurg Spine. 2009 Aug 1; 11 (2): 170-3.

    ObjectThe 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).MethodsThe 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.ResultsMild 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).ConclusionsTreatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score

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