Contemporary Practice Patterns in the Treatment of Cervical Stenosis and Central Cord Syndrome: A Survey of the Cervical Spine Research Society.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-08-05 DOI:10.1097/BSD.0000000000001663

Hannah A Levy, Zachariah W Pinter, Erick R Kazarian, Sonal Sodha, John M Rhee, Michael G Fehlings, Brett A Freedman, Ahmad N Nassr, Brian A Karamian, Arjun S Sebastian, Bradford Currier

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Abstract

Study design: Cross-sectional study.

Objective: To evaluate for areas of consensus and divergence of opinion within the spine community regarding the management of cervical spondylotic conditions and acute traumatic central cord syndrome (ATCCS) and the influence of the patient's age, disease severity, and myelomalacia.

Summary of background data: There is ongoing disagreement regarding the indications for, and urgency of, operative intervention in patients with mild degenerative myelopathy, moderate to severe radiculopathy, isolated axial symptomatology with evidence of spinal cord compression, and ATCCS without myelomalacia.

Methods: A survey request was sent to 330 attendees of the Cervical Spine Research Society (CSRS) 2021 Annual Meeting to assess practice patterns regarding the treatment of cervical stenosis, myelopathy, radiculopathy, and ATCCS in 16 unique clinical vignettes with associated MRIs. Operative versus nonoperative treatment consensus was defined by a management option selected by >80% of survey participants.

Results: Overall, 116 meeting attendees completed the survey. Consensus supported nonoperative management for elderly patients with axial neck pain and adults with axial neck pain without myelomalacia. Operative management was indicated for adult patients with mild myelopathy and myelomalacia, adult patients with severe radiculopathy, elderly patients with severe radiculopathy and myelomalacia, and elderly ATCCS patients with pre-existing myelopathic symptoms. Treatment discrepancy in favor of nonoperative management was found for adult patients with isolated axial symptomatology and myelomalacia. Treatment discrepancy favored operative management for elderly patients with mild myelopathy, adult patients with mild myelopathy without myelomalacia, elderly patients with severe radiculopathy without myelomalacia, and elderly ATCCS patients without preceding symptoms.

Conclusions: Although there is uncertainty regarding the treatment of mild myelopathy, operative intervention was favored for nonelderly patients with evidence of myelomalacia or radiculopathy and for elderly patients with ATCCS, especially if pre-injury myelopathic symptoms were present.

Level of evidence: Level V.

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治疗颈椎管狭窄症和中央型脊髓综合征的当代实践模式：颈椎研究协会调查。

研究设计横断面研究：评估脊柱医学界对颈椎病和急性外伤性中枢性脊髓综合征（ATCCS）治疗的共识和分歧，以及患者年龄、疾病严重程度和脊髓空洞症的影响：关于轻度退行性脊髓病、中度至重度根性病变、有脊髓压迫证据的孤立性轴向症状以及无髓样病变的 ATCCS 患者的手术干预指征和紧迫性，目前仍存在分歧：我们向330名参加颈椎研究学会（CSRS）2021年年会的与会者发出了调查请求，以评估在16个独特的临床案例中治疗颈椎管狭窄、脊髓病、根病和ATCCS的实践模式以及相关的磁共振成像。手术与非手术治疗共识的定义是，超过 80% 的调查参与者选择了一种治疗方案：共有 116 名与会者完成了调查。对于患有轴性颈部疼痛的老年患者和患有轴性颈部疼痛但无髓样病变的成人患者，共识支持非手术治疗。手术治疗适用于患有轻度脊髓病和脊髓空洞症的成人患者、患有严重根性颈椎病的成人患者、患有严重根性颈椎病和脊髓空洞症的老年患者以及原有脊髓病症状的老年ATCCS患者。对于有孤立性轴向症状和骨髓炎的成年患者，发现治疗差异更倾向于非手术治疗。对于轻度脊髓病变的老年患者、轻度脊髓病变但无脊髓空洞症的成人患者、重度根性脊髓病变但无脊髓空洞症的老年患者以及无既往症状的老年ATCCS患者，治疗差异更倾向于手术治疗：尽管轻度脊髓病的治疗方法尚不确定，但有证据表明存在脊髓空洞症或根神经病的非老年患者以及患有ATCCS的老年患者更倾向于手术干预，尤其是在受伤前存在脊髓病症状的情况下：证据等级：V 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.