Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome

Michael G. Fehlings M.D., Ph.D., F.R.C.S.C. 1 and Babak Arvin M.B.B.S., Ph.D., F.R.C.S.(SN) 2
View More View Less
  • 1 Department of Surgery, Division of Neurosurgery, University of Toronto; and
  • 2 Krembil Neuroscience Centre Spinal Program, Toronto Western Hospital, Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

In this special edition of Journal of Neurosurgery: Spine, a series of systematic reviews sponsored by the Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons/Congress of Neurological Surgeons is presented. This collection of comprehensive reviews summarizes the medical evidence related to the surgical management of cervical degenerative disc disease. Several of the key conclusions are discussed in this introduction to the issue:

  • There is Class II evidence to suggest that the clinical condition remains stable when observed over a 3-year period in patients with mild-to-moderate cervical spondylotic myelopathy (CSM) and age younger than 75 years.
  • There is consistent Class III evidence that the duration of symptoms, and possibly advancing age, negatively affect outcome in patients with CSM.
  • There is Class II evidence that somatosensory evoked potentials have prognostic value in patients with CSM. There is Class I evidence to show that electromyographic abnormalities (as well as the presence of radiculopathy) are predictive of the development of myelopathy in minimally symptomatic patients with cervical stenosis and spinal cord compression.
  • The presence of a low signal on T1-weighted images, high signal on T2-weighted images, and the presence of cord atrophy on preoperative MR images are indicators of a poor outcome in CSM.
  • There is Class III evidence to show that anterior or posterior surgical approaches that effectively decompress the cervical canal promote short-term improvements in outcome. However, there appears to be a risk of late kyphosis in patients who undergo laminectomy or anterior cervical discectomy alone compared with patients in whom decompression is combined with fusion.
  • The use of BMP-2 is discouraged for anterior cervical spine surgery based on evidence suggesting that the risks outweigh any potential benefits.

Finally, in patients with symptomatic cervical radiculopathy, arthroplasty achieves outcomes that are equivalent to anterior cervical decompression and fusion, although evidence for superiority is lacking.

Further prospective longitudinal data are required to better define the role and timing of surgical intervention in CSM and to determine the appropriate use of cervical arthroplasty in the management of symptomatic cervical degenerative disc disease.

Abbreviations used in this paper: ACD = anterior cervical discectomy; ACDF = anterior cervical discectomy with fusion; CSM = cervical spondylotic myelopathy; EMG = electromyography; mJOA = modified Japanese Orthopaedic Association.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Michael G. Fehlings, M.D., Ph.D., F.R.C.S.C., Department of Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada. email: michael.fehlings@uhn.on.ca.
  • 1

    Adams CB, & Logue V: Studies in cervical myelopathy. II. The movement and coutour of the spine in relation to the neural complications of cervical spondylosis. Brain 94:568586, 1971

    • Search Google Scholar
    • Export Citation
  • 2

    Bednarik J, , Kadanka Z, , Dusek L, , Novotny O, , Surelova D, & Urbanek I, : Presymptomatic spondylotic cervical cord compression. Spine 29:22602269, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Carette S, & Fehlings MG: Clinical practice. Cervical radiculopathy. N Eng J Med 353:392329, 2005

  • 4

    Fehlings M, , Kopjar B, , Massicotte E, , Arnold P, , Yoon ST, & Vaccaro A, : Surgical treatment for cervical spondylotic myelopathy: one year outcomes of a prospective multicenter study of 316 patients. Spine J 8:1 Suppl 33S34S, 2008. (Abstract #68)

    • Search Google Scholar
    • Export Citation
  • 5

    Heary RF, , Ryken TC, , Matz PG, , Anderson PA, , Groff MW, & Holly LT, : Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine 11:198202, 2009

    • Search Google Scholar
    • Export Citation
  • 6

    Holly LT, , Matz PG, , Anderson PA, , Groff MW, , Heary RF, & Kaiser MG, : Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine 11:112118, 2009

    • Search Google Scholar
    • Export Citation
  • 7

    Kadanka Z, , Mares M, , Bednarík J, , Smrcka V, , Krbec M, & Stejskal L, : Approaches to spondylotic cervical myelopathy. Spine 27:22052211, 2002

    • Search Google Scholar
    • Export Citation
  • 8

    Kaiser MG, , Mummaneni PV, , Matz PG, , Anderson PA, , Groff MW, & Heary RF, : Management of anterior cervical pseudarthrosis. J Neurosurg Spine 11:228237, 2009

    • Search Google Scholar
    • Export Citation
  • 9

    Kelleher MO, , Tan G, , Sarjeant R, & Fehlings MG: Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 8:215221, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    Laws MD Jr, , Bernhardt M, & White AA III: Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect 44:99110, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Matz PG, , Anderson PA, , Groff MW, , Heary RF, , Holly LT, & Kaiser MG, : Cervical laminoplasty for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:157169, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Matz PG, , Anderson PA, , Holly LT, , Groff MW, , Heary RF, & Kaiser MG, : The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 11:104111, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Matz PG, , Holly LT, , Mummaneni PV, , Anderson PA, , Groff MW, & Heary RF, : Anterior cervical surgery for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:170173, 2009

    • Search Google Scholar
    • Export Citation
  • 14

    Mummaneni PV, , Kaiser MG, , Matz PG, , Anderson PA, , Groff MW, & Heary RF, : Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 11:130141, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Mummaneni PV, , Kaiser MG, , Matz PG, , Anderson PA, , Groff MW, & Heary RF, : Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?. J Neurosurg Spine 11:119129, 2009

    • Search Google Scholar
    • Export Citation
  • 16

    Resnick DK, , Anderson PA, , Kaiser MG, , Groff MW, , Heary RF, & Holly LT, : Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy. J Neurosurg Spine 11:245252, 2009

    • Search Google Scholar
    • Export Citation
  • 17

    Ryken TC, , Heary RF, , Matz PG, , Anderson PA, , Groff MW, & Holly LT, : Cervical laminectomy for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:142149, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Ryken TC, , Heary RF, , Matz PG, , Anderson PA, , Groff MW, & Holly LT, : Techniques for cervical interbody grafting. J Neurosurg Spine 11:203220, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 963 519 8
Full Text Views 201 51 4
PDF Downloads 215 39 2
EPUB Downloads 0 0 0