TARGETING: SPINE SURGERY 

Journal of Neurosurgical Sciences 2013 September;57(3):241-52

Copyright © 2013 EDIZIONI MINERVA MEDICA

lingua: Inglese

Controversies in the management of cervical spondylotic myelopathy

Chang V., Holly L. T. ✉

Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, CA, USA

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.