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Controversies in the management of cervical spondylotic myelopathy
1Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, CA, USA - lholly@mednet.ucla.edu.
Aim:
Cervical spondylotic myelopathy (CSM) is a common clinical entity that can be a significant cause of disability in the adult population. Although our CSM knowledge has markedly grown in recent years, a variety of controversies exist regarding the optimal treatment strategies. The goal of this paper is to review and discuss current areas of controversy in the management of CSM patients.
Methods:
Topics addressed in this manuscript include: operative versus nonoperative management for patients with mild CSM, optimal surgical approaches for CSM, the utility of intraoperative monitoring, and radiographical prognostic indicators for outcome following surgery for CSM.
Results:
A current review reveals several areas where Class I evidence exists regarding these controversies. However, many other studies consist contain Class III or weaker data, thereby making it difficult to draw any definitive conclusions. Despite the lack of a consensus in some areas, it appears that CSM patients can often achieve satisfactory treatment through a variety of different options.
Conclusion:
CSM remains a challenging clinical problem where several areas of controversy still exist. Large, multi-center, randomized prospective trials will be required to help resolve some of the controversies.
