Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years

Eur Spine J, 2011 · DOI: 10.1007/s00586-011-1811-9 · Published: April 26, 2011

Simple Explanation

This study investigates whether surgery is better than conservative treatment for mild to moderate cervical spondylotic myelopathy (CSM) over a 10-year period. Patients were randomly assigned to either surgical or conservative treatment groups, and their clinical outcomes were compared using various assessments. The study found no significant difference in outcomes between the two groups, suggesting that both approaches have similar long-term results for this patient population.

Study Duration

10 Years

Participants

64 patients with mild to moderate CSM

Evidence Level

Level I, Prospective Randomized Controlled Trial

Key Findings

1
There was no statistically significant difference between conservatively and surgically treated groups in mJOA score.
2
There was neither any difference found in the percentage of patients losing the ability to walk nor in the time taken to cover the 10-m track from a standing start.
3
Seventeen patients across the groups studied died of natural causes in the course of the follow-up.

Research Summary

This 10-year prospective randomised study compared conservative and surgical treatments for mild and moderate CSM. The study found no significant difference in clinical outcomes between the two treatment groups, as measured by mJOA score, subjective evaluation, video recordings of daily activities, and walking ability. The authors conclude that for mild to moderate CSM, neither conservative nor surgical treatment demonstrated a clear advantage over the other in the long term.

Practical Implications

Treatment Decision-Making

Clinicians can consider both conservative and surgical approaches as viable options for mild to moderate CSM, tailoring the choice to individual patient factors and preferences.

Further Research

Larger studies with more precise patient selection criteria are needed to identify subgroups of patients who may benefit more from one treatment approach over the other.

Patient Education

Patients should be informed about the similar long-term outcomes of both conservative and surgical treatments to facilitate shared decision-making.

Study Limitations

1
Low number of patients for the ﬁnal evaluation
2
Clinically negligible differences between two compared arms
3
Study suffers from decreased sample size due to events which cannot be expected, including death of patients

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