Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy.
OBJECTIVE
The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery.


METHODS
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to clinical preoperative factors. Abstracts were reviewed, and studies that met 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/Congress of Neurological Surgeons.


RESULTS
Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III).


CONCLUSIONS
Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.
Holly
Langston T
LT
Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA.
Matz
Paul G
PG
Anderson
Paul A
PA
Groff
Michael W
MW
Heary
Robert F
RF
Kaiser
Michael G
MG
Mummaneni
Praveen V
PV
Ryken
Timothy C
TC
Choudhri
Tanvir F
TF
Vresilovic
Edward J
EJ
Resnick
Daniel K
DK
D000367:Age Factors; D002574:Cervical Vertebrae / Q000601:surgery*; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D011379:Prognosis; D013118:Spinal Cord Diseases / Q000503:physiopathology / Q000601:surgery*; D055009:Spondylosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome