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Speakers debate treatment methods for cervical myelopathy

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BOSTON — Speakers at the Congress of Neurological Surgeons Annual Meeting presented differing opinions on the use of surgery and conservative treatment for addressing cervical myelopathy.

In patients with cervical myelopathy, surgery is effective in decompressing the spinal cord and treating spinal cord symptoms, Zoher Ghogawala, MD, said during a presentation here.

Studies comparing surgery to conservative treatments for cervical myelopathy have yet to be performed, however, and the lack of available data means comparing the two treatments is not ethical or feasible, according to Ghogawala.

“So, when a patient with cervical myelopathy comes to your office, you need to think of the following things: One, do I understand that cervical myelopathy results from ongoing spinal cord injury? Two, do I want to help this patient? Three, do I have the skills to safely decompress the spinal cord and stabilize the spinal column without major complications? If the answer is yes, then help your patient,” he said.

James S. Harrop, MD, disagreed, saying that in the published literature, conservative-treatment patients had very similar health outcomes when compared with patients who underwent surgery.

Harrop pointed to a retrospective study by Hiroki Yoshimatsu, MD, of 69 cases in which the researchers strived to understand the effects and limitations of conservative treatment for spinal cord compression. The researchers concluded conservative treatment was considered to be effective if performed intensely in selected patients, according to Harrop.

“Timely surgery intervention is important; it should be employed. But overall, conservative or non-operative treatment is essential in the management of cervical myelopathy,” he said. — by Robert Linnehan

Reference:

Ghogawala Z, Harrop JS. Surgery vs. conservative care for cervical myelopathy. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Disclosures: Ghogawala has no relevant financial disclosures. Harrop has a consulting agreement with Bioventus, is a consultant for DePuy Spine and Tejin, is a trustee with AOSpine, and receives honoraria from Globus.