Considerations for prophylactic surgery in asymptomatic severe cervical stenosis: review article.
BACKGROUND
Cervical spondylotic myelopathy (CSM) is a devastating pathology that can severely impair quality of life. The symptoms in CSM progress slowly and often do not manifest until they become severe and potentially irreversible. There is a consensus that surgical intervention is warranted in symptomatic patients. The recovery of the neurologic deficit after surgical decompression of the spinal cord varies, and halting the progression of the disease remains the principle aim of surgery.


OBJECTIVE
The aim of this review is to address the key question of whether or not to intervene in cases that have radiographic evidence of significant cervical stenosis yet are asymptomatic or exhibit minimal symptoms?


METHODS
The PubMed databases for publications that addressed asymptomatic cervical spondylotic myelopathy were reviewed. The relevant articles were selected after screening all the resulting abstracts. The references of the relevant articles were then reviewed, and cross references with titles discussing CSM were picked up for review.


RESULTS
The search identified 14 papers which were reviewed. Seven articles were found to be relevant to the subject in question. Going through the references of the relevant articles, three articles were found to be directly related to the topic in study.


CONCLUSIONS
There is paucity of evidence to support for or against surgery in the setting of asymptomatic cervical spondylotic myelopathy despite radiographic evidence of severe stenosis. Patient factors such as age, level of activity, and risk of injury should be considered in formulating a management plan. Moreover, the patient should play an integral role in the process of decision making.
Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
Abdel Majid
AM
Sheikh Taha
Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Jennifer
J
Shue
Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
Darren
D
Lebl
Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065 USA.
Federico
F
Girardi
Japanese orthopedic association classification; Ranawat classification; cervical spondylotic myelopathy; cervical stenosis; mild cervical spondylotic myelopathy; nonoperative treatment; severe cervical stenosis; surgical treatment