A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression

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dc.contributor.authorFehlings, Michael G.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorRiew, K. Daniel
dc.contributor.authorMiddleton, James W.
dc.contributor.authorAarabi, Bizhan
dc.contributor.authorArnold, Paul M.
dc.contributor.authorBrodke, Darrel S.
dc.contributor.authorBurns, Anthony S.
dc.contributor.authorCarette, Simon
dc.contributor.authorChen, Robert
dc.contributor.authorChiba, Kazuhiro
dc.contributor.authorDettori, Joseph R.
dc.contributor.authorFurlan, Julio C.
dc.contributor.authorHarrop, James S.
dc.contributor.authorHolly, Langston T.
dc.contributor.authorKalsi-Ryan, Sukhvinder
dc.contributor.authorKotter, Mark
dc.contributor.authorKwon, Brian K.
dc.contributor.authorMartin, Allan R.
dc.contributor.authorMilligan, James
dc.contributor.authorNakashima, Hiroaki
dc.contributor.authorNagoshi, Narihito
dc.contributor.authorRhee, John
dc.contributor.authorSingh, Anoushka
dc.contributor.authorSkelly, Andrea C.
dc.contributor.authorSodhi, Sumeet
dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorYee, Albert
dc.contributor.authorWang, Jeffrey C.
dc.contributor.funderKrembil Foundation
dc.contributor.funderDeZwirek
dc.contributor.funderGerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funderCervical Spine Research Society
dc.contributor.funderAOSpine
dc.date.accessioned2018-06-15T11:47:12Z
dc.date.available2018-06-15T11:47:12Z
dc.date.issued2017
dc.description.abstractStudy Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) "We recommend surgical intervention for patients with moderate and severe DCM." (2) "We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve." (3) "We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically." (4) "Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above." Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.en
dc.description.sponsorshipKrembil Foundation (Postdoctoral Fellowship Award)en
dc.description.statusPeer reviewed
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFehlings, M. G., Tetreault, L. A., Riew, K. D., Middleton, J. W., Aarabi, B., Arnold, P. M., Brodke, D. S., Burns, A. S., Carette, S., Chen, R., Chiba, K., Dettori, J. R., Furlan, J. C., Harrop, J. S., Holly, L. T., Kalsi-Ryan, S., Kotter, M., Kwon, B. K., Martin, A. R., Milligan, J., Nakashima, H., Nagoshi, N., Rhee, J., Singh, A., Skelly, A. C., Sodhi, S., Wilson, J. R., Yee, A. and Wang, J. C. (2017) 'A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression', Global Spine Journal, 7(3S), pp. 70S-83S. doi: 10.1177/2192568217701914en
dc.identifier.doi10.1177/2192568217701914
dc.identifier.endpage83S
dc.identifier.issn2192-5682
dc.identifier.journaltitleGlobal Spine Journalen
dc.identifier.startpage70S
dc.identifier.urihttps://hdl.handle.net/10468/6332
dc.identifier.volume7
dc.language.isoenen
dc.publisherSage Publishingen
dc.relation.urihttp://journals.sagepub.com/doi/10.1177/2192568217701914
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.urihttp://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectGuidelinesen
dc.subjectDegenerative cervical myelopathyen
dc.subjectCervical spondylotic myelopathyen
dc.subjectSpinal cord compressionen
dc.titleA clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compressionen
dc.typeArticle (peer-reviewed)en
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