login
  Password reminder
Spinal News
Contact the editor Visit Spinal News Twitter feed Visit Spinal News Facebook page
 

Managing cervical spondylotic myelopathy


Wednesday, 25 Jul 2012 17:17
K Daniel Riew
K Daniel Riew


The management of cervical spondylotic myelopathy remains controversial and the topic is the focus of a session at this year’s IMAST. The moderator of the session, K Daniel Riew, Mildred B Simon professor of Orthopedic Surgery, chief of Cervical Spine Surgery, Washington University Orthopedics, St Louis, USA, talked to Spinal News International about these controversies and the dangers of bad surgery


Conservative treatment for cervical spondylotic myelopathy is often initiated on the basis of clinician preference. Which conservative treatments do you prefer to use?

I use anti-inflammatories, neck immobilisation with a collar, and observation.

The BMJ recently ran a debate on cervical spinal manipulation for mechanical neck pain in which one side1 argued that the practice should be abandoned because its risks outweighed its benefits. What is your view?


Most patients can receive spinal manipulation. If they have severe spinal cord compression, then I do not recommend it. However, I have seen thousands of patients who have undergone chiropractic spinal manipulation and I can count on one hand the number of patients who have been harmed by it—there are many more patients who have been harmed by bad spinal operations.

What are the main, unresolved, controversies concerning the surgical management of cervical spondylotic myelopathy?

The main controversies include anterior approach vs. posterior approach, when to operate, and how to manage patients with spinal cord compression with or without cord signal change without myelopathy.

What data are there for minimally invasive surgical techniques for CSM?

It depends on the definition of “minimally invasive”. For example, compared with fusion, laminoplasty is a minimally invasive technique and there is ample data that it works very well in indicated cases. Otherwise, as long as the decompression is adequate, minimally invasive surgery has the potential to work as well as any other approach.

However, it is very important that techniques that employ minimal visualisation and fluoroscopic guidance are done carefully as there is a great risk of harm. I have seen nerve roots injured, paralysis, inadequate decompressions, spinal instability and muscle maceration and denervation caused by “minimally invasive” posterior decompressions. These procedures, done with poor technique, can result in high doses of radiation to the patient, as well as the staff. Last week I saw a patient who had had a posterior decompression done bilaterally through two 2cm incisions. The muscles in the back of the neck were markedly atrophied. It is obvious that through these “small” incisions, the surgeon macerated the muscle. This is “minimal incision, maximal muscle killing surgery” done by someone who only paid attention to the incision size and not what is beneath the surface. A careful surgeon treats what is beneath the skin with as much respect and care as the surface, which is the only part that the patient sees. ­

As many patients with cervical spondylotic myelopathy are elderly, what are the age-related complications of surgery that surgeons need to be aware of?

Patients may have osteoporosis, which can result instrument-failure fractures, or they may have age-related balance problems as well as having myelopathy. Potential medical complications in elderly patients include cardiac, pulmonary, or renal conditions, and stroke. There is also an increased risk of dysphagia, dysphonia, and aspiration with anterior procedures.

After an operation, patients may develop post-operative confusion. Furthermore, the effects of narcotic pain medication can be magnified with confusion, delirium, constipation, and unsteadiness of gait. There is also the issue of drug interactions with polypharmacy that can occur in an older patient.


References
1. Wand et al. BMJ 2012;344:e3679




Add New Comment

Most popular


New device allows brain to bypass spinal cord and move paralysed limbs
Friday, 27 Jun 2014
For the first time ever, a paralysed man has moved his fingers and hand with his own thoughts after an electronic neural bypass for spinal cord injuries that reconnects the brain directly to muscles, ... New device allows brain to bypass spinal cord and move paralysed limbs

Tantalum porous implant is a good alternative to plate and autograft in ACDF
Friday, 13 Jun 2014
A new study indicates that patients undergoing anterior cervical discectomy and fusion (ACDF) with a tantalum implant have fewer complications and reduced costs at five years compared with patients ... Tantalum porous implant is a good alternative to plate and autograft in ACDF

Level of cervical surgery does not affect postoperative headache relief
Friday, 30 May 2014
A study in the Journal of Neurosurgery: Spine indicates that although patients with cervical spondylolysis at higher levels have significantly greater preoperative headache pain than patients with ... Level of cervical surgery does not affect postoperative headache relief

Features


Can cognitive behavioural therapy help spinal surgery patients return to work and daily life?
Friday, 11 Jul 2014
Nanna Rolving and colleagues have launched a study to investigate the clinical effectiveness and cost-effectiveness of using a multidisciplinary cognitive behavioural intervention to help patients ... Can cognitive behavioural therapy help spinal surgery patients return to work and daily life?

Reducing the need for allogeneic blood transfusions in metastatic spine tumour surgery
Tuesday, 24 Jun 2014
At BritSpine (2–4 April, Warwick, UK), Naresh Kumar presented the results of a systematic review of using intraoperative salvaged blood in metastatic spine tumour surgery to reduce the need for ... Reducing the need for allogeneic blood transfusions in metastatic spine tumour surgery

Profiles


Luiz Pimenta
Thursday, 12 Jun 2014
Luiz Pimenta, immediate past president of the International Society for the Advancement of Spinal S... Luiz Pimenta

Frank Schwab
Thursday, 17 Apr 2014
Frank Schwab (chief of the Spinal Deformity Service, Division of Spine Surgery, New York University,... Frank Schwab

Cardiac Rhythm News Vascular News Cardiovascular News Interventional News Spinal News NeuroNews
BIBA Medical BIBA MedTech Insights CX Symposium ilegx
 
Password Reminder

BIBA Medical, 526 Fulham Road, Fulham, London, SW6 5NR.
TEL: +44 (0)20 7736 8788 FAX: +44 (0)20 7736 8283 EMAIL: 
info@bibamedical.com
© BIBA Medical Ltd is a company registered in England and Wales with company number 2944429.
VAT registration number 730 6811 50.
Site Map | Terms and Conditions