Conservative treatment for cervical spondylotic myelopathy

Yoshimatsu, Hiroki; Nagata, Kensei; Gotô, Hiroshi; Sonoda, Kyosuke; Ando, Noriyuki; Imoto, Hiroki; Mashima, Takeru; Takamiya, Yoshiaki

doi:10.1016/s1529-9430(01)00082-1

Cited by 76 publications

(26 citation statements)

References 16 publications

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“…Sampath et al 32 concluded that surgery was associated with improved functional status, improved neurologic status and improved patient satisfaction. Yoshimatsu et al 33 retrospectively compared patients with CSM elected to undergo either immediate surgical treatment (32 patients, JOA <13) or conservative care (69 patients, JOA >13). The authors found that surgically treated patients demonstrated greater improvements than the conservative group.…”

Section: Conservative Versus Surgical Approachmentioning

confidence: 99%

Current Diagnosis and Management of Cervical Spondylotic Myelopathy

Bakhsheshian

Mehta

Liu

2017

Global Spine Journal

242

227

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Study Design:Review.Objectives:Cervical spondylotic myelopathy (CSM) is a major cause of disability, particular in elderly patients. Awareness and understanding of CSM is imperative to facilitate early diagnosis and management. This review article addresses CSM with regard to its epidemiology, anatomical considerations, pathophysiology, clinical manifestations, imaging characteristics, treatment approaches and outcomes, and the cost-effectiveness of surgical options.Methods:The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives.Results:The clinical presentation and natural history of CSM is variable, alternating between quiescent and insidious to stepwise decline or rapid neurological deterioration. For mild CSM, conservative options could be employed with careful observation. However, surgical intervention has shown to be superior for moderate to severe CSM. The success of operative or conservative management of CSM is multifactorial and high-quality studies are lacking. The optimal surgical approach is still under debate, and can vary depending on the number of levels involved, location of the pathology and baseline cervical sagittal alignment.Conclusions:Early recognition and treatment of CSM, before the onset of spinal cord damage, is essential for optimal outcomes. The goal of surgery is to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high. Further high-quality randomized clinical studies with long-term follow up are still needed to further define the natural history and help predict the ideal surgical strategy.

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Section: Conservative Versus Surgical Approachmentioning

confidence: 99%

Current Diagnosis and Management of Cervical Spondylotic Myelopathy

Bakhsheshian

Mehta

Liu

2017

Global Spine Journal

242

227

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“…[ 26 ] Multivariate analysis revealed that the duration of initial conservative treatment did not affect the rate of improvement after surgery. [ 5 ] Therefore, prompt and intensive conservative treatment is recommended for patients with mild CSM without neurological deterioration for clinical effectiveness. [ 5 ] This patient was a good candidate for integrative KM treatment rather than immediate surgery because his mJOA score was mild and disease duration was short.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] Therefore, prompt and intensive conservative treatment is recommended for patients with mild CSM without neurological deterioration for clinical effectiveness. [ 5 ] This patient was a good candidate for integrative KM treatment rather than immediate surgery because his mJOA score was mild and disease duration was short. He also had several underlying diseases such as angina pectoris, hypertension, and dyslipidemia.…”

Section: Discussionmentioning

confidence: 99%

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Integrative Korean medicine as a possible conservative treatment for mild cervical spondylotic myelopathy

Kim

Cho²,

Nam³

et al. 2018

Medicine

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Rationale:Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder in older patients. The purpose of this case report is to introduce conservative treatment with integrative Korean medicine (KM) as a possible alternative to surgery in patients with mild CSM.Patient concerns:An 81-year-old male with both hand weakness and dysesthesia was diagnosed with CSM and was recommended laminectomy. However, considering the patient's age and the underlying disease, he refused immediate surgery and preferred KM treatmentDiagnoses:The diagnosis of mild CSM was based on a modified Japanese Orthopedic Association (mJOA) score as well as the presence of compression on the spinal cord in magnetic resonance imaging findingsInterventions:Integrative KM treatment consisting of acupuncture, acupotomy, Bee venom herbal acupuncture, cupping therapy, moxibustion, and herbal medicine was provided during the 12-week admission.Outcomes:Clinical improvement was detected with a mJOA score (11 to 17), a numerical rating scale for dysesthesia intensity (5 to 2), finger escape sign (+/+ to +/−), grip and release test (11/14 to 32/31) and grasp power measured by dynamometer (3.1/9.7 to 10.8/18.3 kg) at 12 weeks. This improvement was maintained without surgery until 1 year.Lessons:This case suggests that integrative KM was a possible conservative management option for mild CSM.

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“…Subsequently, Sumi et al (8) further followed the same patients for >5 years and reported that the presence of angular-edged deformities of the spinal cord in T1-weighted axial MRI is another risk factor that aggravates myelopathy. Yoshimatsu et al (15) analyzed the results of conservative treatment for CSM in 69 cases and concluded that the disease duration correlated significantly with the clinical outcome. However, Oshima et al (7) indicated that a large range of motion (ROM) and segmental instability at the narrowest canal are considered to be adverse prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy

Kong

Meng

Wang

et al. 2013

Experimental and Therapeutic Medicine

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The optimal management approach for patients with mild forms of cervical spondylotic myelopathy (MCSM) has not been well established. The aim of the present study was to investigate the outcome of conservative treatment, identify prognostic factors and provide evidence for the timing of surgical intervention. A total of 90 patients with MCSM attending hospital between February 2007 and January 2009 were prospectively enrolled. Initially, all patients received conservative treatment and were followed up periodically. When a deterioration in myelopathy was clearly identified, surgical treatment was conducted. Clinical and radiological factors correlating with the deterioration were examined, and final clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score. At the end of January 2012, follow-ups of >3 years were completed. Seventy-eight patients were available for data analysis. Only 21 patients (26.9%) deteriorated and underwent surgery thereafter (group A), while the remaining 57 patients (73.1%) were treated conservatively throughout (group B). Statistical analysis revealed that segmental instability and cervical spinal stenosis were adverse factors for the prognosis of conservative treatment. Although the JOA scores of the patients in group A declined initially, following surgical intervention, no significant differences were identified in JOA scores between the two groups at the time of the final follow-up (P=0.46). In summary, conservative treatment is effective in MCSM patients. Patients with segmental instability and cervical spinal stenosis have a tendency to deteriorate, but conservative treatment remains the recommendation for the first action. If the myelopathy deteriorates during conservative treatment, timely surgical intervention is effective.

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Conservative treatment for cervical spondylotic myelopathy

Cited by 76 publications

References 16 publications

Current Diagnosis and Management of Cervical Spondylotic Myelopathy

Current Diagnosis and Management of Cervical Spondylotic Myelopathy

Integrative Korean medicine as a possible conservative treatment for mild cervical spondylotic myelopathy

Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy

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