How beneficial is surgery for cervical radiculopathy and myelopathy?

Spondylotic degeneration of the cervical spine is associated with ageing and is often asymptomatic, 1 but 10-15% of people with the condition might develop symptoms of compression of the nerve roots (radiculopathy) or spinal cord (myelopathy). 2 Many factors have been implicated in the tendency to d...

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Bibliographic Details
Published in:BMJ 2010-07, Vol.341 (jul13 2), p.c3108-c3108
Main Authors: Fouyas, Ioannis P, Sandercock, Peter A G, Statham, Patrick F X, Nikolaidis, Ioannis
Format: Article
Language:English
Subjects:
Central nervous system diseases
Compression
Degeneration
Epidemiology
Esophagus
Exercise
Humans
Magnetic resonance imaging
Medical diagnosis
Natural history
NMR
Nuclear magnetic resonance
Pain
Paraplegia
Radiculopathy - surgery
Spinal cord
Spinal Cord Diseases - surgery
Spine
Spine (cervical)
Surgery
Surgical outcomes
Treatment Outcome
Vertebrae
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Summary:Spondylotic degeneration of the cervical spine is associated with ageing and is often asymptomatic, 1 but 10-15% of people with the condition might develop symptoms of compression of the nerve roots (radiculopathy) or spinal cord (myelopathy). 2 Many factors have been implicated in the tendency to develop radiculopathy or myelopathy, including advanced age, disability at presentation, cord diameter, cord area, altered cord signal on magnetic resonance imaging (T2 and T1 weighted images), 3 increased cervical spinal mobility, 4 5 and the presence of a congenitally narrow spinal canal. [...]the available observational data show that progressive disability is not inevitable, that symptoms might remain static, and patients with apparent disability might improve without surgery. 6 7 8 9 Patients with radicular symptoms do not necessarily progress to develop overt myelopathy, and in one study at five years, 75% had improved spontaneously. 10 A small randomised controlled trial also found that outcomes after surgery might be similar to those of conservative management. 11 Possible complications of surgery include oesophageal perforation, carotid or vertebral artery injury, and permanent damage to nerve roots. 12 Damage to the spinal cord might carry a risk of paraplegia. For our original Cochrane review of the randomised trial evidence on the effect of surgery for cervical radiculopathy or myelopathy we searched BioMed Central, Medline, and Embase up to 1998. [...]non-randomised cohort studies prospectively studying the temporal evolution of myelopathic patients report conflicting results and are unlikely to produce reliable estimates of the balance of risk and benefit from...
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.c3108