Does nonoperative management play a role in the treatment of cervical spondylotic myelopathy?

Abstract

Cervical spondylotic myelopathy has traditionally been managed through surgical decompression with or without reconstruction. Currently, a multicenter, blinded clinical trial that has supported such a therapeutic recommendation does not exist. There have been case-control studies that have and have not shown long-standing benefit to surgical decompression and reconstruction. The purpose of this review is to examine the efficacy of nonoperative therapy for cervical spondylotic myelopathy. It appears that both static and dynamic factors play a role in the pathophysiology of cervical spondylotic myelopathy. Furthermore, once clinical cervical spondylotic myelopathy is evident, progression may occur despite the best of treatments, both surgical and nonsurgical.