Michael G. Fehlings, Toronto Western Hospital; University of TorontoFollow
Lindsay A. Tetreault, Toronto Western Hospital; University College CorkFollow
K. Daniel Riew, Washington University School of MedicineFollow
James W. Middleton, University of SydneyFollow
Bizhan Aarabi, University of Maryland School of MedicineFollow
Paul M. Arnold, The University of KansasFollow
Darrel S. Brodke, University of UtahFollow
Anthony S. Burns, University of TorontoFollow
Simon Carette, University of Toronto
Robert Chen, University of Toronto
Kazuhiro Chiba, National Defense Medical College
Joseph R. Dettori, Spectrum Research, Inc
Julio C. Ferlan, University of Toronto; Toronto Rehabilitation Institute
James S. Harrop, Thomas Jefferson UniversityFollow
Langston T. Holly, University of California at Los AngelesFollow
Sukhvinder Kalsi-Ryan, Toronto Western HospitalFollow
Mark Kotter, University of Cambridge
Brian K. Kwon, Vancouver General HospitalFollow
Allan R. Martin, Toronto Western HospitalFollow
James Milligan, The Centre for Family Medicine; McMaster University; Western University
Hiroaki Nakashima, Nagoya University Graduate School of MedicineFollow
Narihito Nagoshi, Toronto Western Hospital; Keio University School of MedicineFollow
John Rhee, Emory University
Anoushka Singh, Toronto Western HospitalFollow
Andrea C. Skelly, Spectrum Research, Inc
Sumeet Sodhi, Toronto Western Hospital; University of Toronto
Jefferson R. Wilson, University of Toronto; St Michael’s HospitalFollow
Albert Yee, Sunnybrook Health Sciences CentreFollow
Jeffrey C. Wang, USC Spine CenterFollow

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Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.