title: The natural history of cervical spondylotic myelopathy.
abstract: OBJECTIVE
  The objective of this systematic review was to use evidence-based medicine to delineate the natural history of cervical spondylotic myelopathy (CSM) and identify factors associated with clinical deterioration.
  
  
  METHODS
  The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the natural history of CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.
  
  
  RESULTS
  The natural history of CSM is mixed: it may manifest as a slow, stepwise decline or there may be a long period of quiescence (Class III). Long periods of severe stenosis are associated with demyelination and may result in necrosis of both gray and white matter. With severe and/or long lasting CSM symptoms, the likelihood of improvement with nonoperative measures is low. Objectively measurable deterioration is rarely seen acutely in patients younger than 75 years of age with mild CSM (modified Japanese Orthopaedic Association scale score > 12; Class I). In patients with cervical stenosis without myelopathy, the presence of abnormal electromyography findings or the presence of clinical radiculopathy is associated with the development of symptomatic CSM in this patient population (Class I).
  
  
  CONCLUSIONS
  The natural history of CSM is variable, which may affect treatment decisions.
authors.affiliation: Division of Neurological Surgery, University of Alabama, Birmingham, Alabama, USA. matzpg@yahoo.com
authors.forename: Paul G
authors.initials: PG
authors.lastname: Matz
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Langston T
authors.initials: LT
authors.lastname: Holly
authors.forename: Michael W
authors.initials: MW
authors.lastname: Groff
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kaiser
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Ryken
authors.forename: Tanvir F
authors.initials: TF
authors.lastname: Choudhri
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Vresilovic
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D013118:Spinal Cord Diseases / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D055009:Spondylosis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology