Journal Content
Cervical Spondylotic Myelopathy
Degenerative cervical spondylotic disease represents one of the most common indications for spinal surgery in the United States. In the year 2000, Patil et al reported that 112,400 cervical spine procedures were performed in the US for degenerative disease. This represents a 100% increase in utilization over a decade with hospital charges of greater than 2 billion/ year. (Patil et al, Neurosurgery 2005;57:753-758) Using the national inpatient sample, utilization of cervical fusion procedures has increased 89% in the last 10 years (now 50 cases/ 100,000 people/ year). (Cowan et al, Neurosurgery 2006;59:15-20).
Degenerative spine disorders pose significant challenges for the surgeon interested in clinical trials. Cervical spondylotic myelopathy (CSM), one such disorder, is a common cause of neurological morbidity that often results in gait instability, bladder dysfunction, and difficulty with fine motor function in the hands. Surgical decompression for CSM is often advocated. The optimal surgical strategy, however, remains controversial, with a wide variety of surgical approaches (“ventral versus dorsal”) being used. The heterogeneity of patient populations, differences in surgical technique, and lack of uniform outcomes data all contribute to the difficulties associated with the interpretation of published studies. No systematic review using a meta-analysis of this literature has been published to date. Lack of consensus amongst specialists makes it difficult for the medical practitioner to determine the optimal management for patients with CSM. Many have proposed a randomized controlled trial (RCT).