Nonoperative versus operative management for the treatment degenerative cervical myelopathy: an updated systematic review

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dc.contributor.author Rhee, John
dc.contributor.author Tetreault, Lindsay A.
dc.contributor.author Chapman, Jens R.
dc.contributor.author Wilson, Jefferson R.
dc.contributor.author Smith, Justin S.
dc.contributor.author Martin, Allan R.
dc.contributor.author Dettori, Joseph R.
dc.contributor.author Fehlings, Michael G.
dc.date.accessioned 2018-03-09T12:55:06Z
dc.date.available 2018-03-09T12:55:06Z
dc.date.issued 2017
dc.identifier.citation Rhee, J., Tetreault, L. A., Chapman, J. R., Wilson, J. R., Smith, J. S., Martin, A. R., Dettori, J. R. and Fehlings, M. G. (2017) 'Nonoperative versus operative management for the treatment degenerative cervical myelopathy: an updated systematic review', Global Spine Journal, 7(3S), pp. 35-41. doi: 10.1177/2192568217703083 en
dc.identifier.volume 7
dc.identifier.issued 3S
dc.identifier.startpage 35
dc.identifier.endpage 41
dc.identifier.issn 2192-5682
dc.identifier.uri http://hdl.handle.net/10468/5593
dc.identifier.doi 10.1177/2192568217703083
dc.description.abstract Study Design: Systematic review (update). Objective: Degenerative cervicalmyelopathy(DCM) is a progressive degenerative spine disease that is increasingly managed surgically. The objective of this study is to determine the role of nonoperative treatment in the management of DCM by updating a systematic review published by Rhee and colleagues in 2013. The specific aims of this review were (1) to determine the comparative efficacy, effectiveness, and safety of nonoperative and surgical treatment; (2) to assess whether myelopathy severity differentially affects outcomes of nonoperative treatment; and(3) to evaluate whether activities or minor injuries are associated with neurological deterioration. Methods: Methods from the original review were used to search for new literature published between July 20, 2012, and February 12, 2015. Results: The updated search yielded 2 additional citations that met inclusion criteria and compared the efficacy of conservative management and surgical treatment. Based on a single retrospective cohort, there were no significant differences in post treatment Japanese Orthopaedic Association (JOA) or Neck Disability Index scores or JOA recovery ratios between patients treated nonoperatively versus operatively. A second retrospective study indicated that the incidence rate of hospitalization for spinal cord injury was 13.9 per 1000 person-years in a nonoperative group compared with 9.4 per 1000 person-years in a surgical group (adjusted hazard ratio = 1.57; 95% confidence interval = 1.11-2.22; P = .011). Conclusion: Nonoperative management results in similar outcomes as surgical treatment in patients with a modified JOA >= 13, single-level myelopathy and intramedullary signal change on T2-weighted magnetic resonance imaging. Furthermore, patients managed nonoperatively for DCM have higher rates of hospitalization for spinal cord injury than those treated surgically. The overall level of evidence for these findings was rated as low. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Sage Publications en
dc.relation.uri http://journals.sagepub.com/doi/10.1177/2192568217703083
dc.rights © 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). en
dc.rights.uri http://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject Cervical spondylotic myelopathy en
dc.subject Degenerative cervical myelopathy en
dc.subject Nonoperative management en
dc.subject Systematic review en
dc.title Nonoperative versus operative management for the treatment degenerative cervical myelopathy: an updated systematic review en
dc.type Review en
dc.internal.authorcontactother Lindsay A. Tetreault, Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email: 116100017@umail.ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder AOSpine
dc.contributor.funder Cervical Spine Research Society
dc.contributor.funder Gerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funder DeZwirek Family Foundation
dc.contributor.funder Krembil Foundation
dc.description.status Peer reviewed en
dc.identifier.journaltitle Global Spine Journal en


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© 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Except where otherwise noted, this item's license is described as © 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
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