National Guideline Clearinghouse | The natural history of cervical spondylotic myelopathy.

Guideline Title
The natural history of cervical spondylotic myelopathy.

Bibliographic Source(s)
Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, Mummaneni PV, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves [trunc]. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 2009 Aug;11(2):104-11. [20 references] PubMed

Guideline Status
This is the current release of the guideline.


full-text:
National Guideline Clearinghouse | The natural history of cervical spondylotic myelopathy.







J Neurosurg Spine. 2009 Aug;11(2):104-11.

The natural history of cervical spondylotic myelopathy.

Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, Mummaneni PV, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK; Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

Source
Division of Neurological Surgery, University of Alabama, Birmingham, Alabama, USA. matzpg@yahoo.com

Abstract
OBJECT: The objective of this systematic review was to use evidence-based medicine to delineate the natural history of cervical spondylotic myelopathy (CSM) and identify factors associated with clinical deterioration.

METHODS: The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the natural history of CSM. Abstracts were reviewed and studies meeting the 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 and the Congress of Neurological Surgeons.

RESULTS: The natural history of CSM is mixed: it may manifest as a slow, stepwise decline or there may be a long period of quiescence (Class III). Long periods of severe stenosis are associated with demyelination and may result in necrosis of both gray and white matter. With severe and/or long lasting CSM symptoms, the likelihood of improvement with nonoperative measures is low. Objectively measurable deterioration is rarely seen acutely in patients younger than 75 years of age with mild CSM (modified Japanese Orthopaedic Association scale score > 12; Class I). In patients with cervical stenosis without myelopathy, the presence of abnormal electromyography findings or the presence of clinical radiculopathy is associated with the development of symptomatic CSM in this patient population (Class I).

CONCLUSIONS: The natural history of CSM is variable, which may affect treatment decisions.

PMID:19769489[PubMed - indexed for MEDLINE]
The natural history of cervical spondylotic myelop... [J Neurosurg Spine. 2009] - PubMed result