Journal of neurosurgery. Spine
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Practice Guideline
Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy.
The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. ⋯ Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific-it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).
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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. ⋯ 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.
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Practice Guideline
Cervical laminectomy for the treatment of cervical degenerative myelopathy.
The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy for the treatment of cervical spondylotic myelopathy (CSM). ⋯ Laminectomy is an acceptable therapy for near-term functional improvement of CSM (Class III). It is associated with development of kyphosis, however.
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Practice Guideline
Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy.
The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. ⋯ Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99%).
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The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy (CSM). ⋯ Laminectomy with fusion (arthrodesis) is an effective strategy to improve functional outcome in CSM and OPLL.