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Clinical Equipoise and Treatment Decisions in Cervical Spondylotic Myelopathy

Published online by Cambridge University Press:  02 December 2014

Michael Benatar
Michael Benatar*
Affiliation:
Department of Neurology, Emory University, The Emory Clinic, Atlanta, GA, USA
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Abstract

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Objective:

The primary objective of this study is to evaluate clinician attitudes towards the treatment of cervical spondylotic myelopathy (CSM) in order to determine whether clinical equipoise exists for a segment of this patient population. The secondary objective is to examine the factors that influence treatment decisions.

Methods:

Cross-sectional internet-based survey of neurologists, neurosurgeons and orthopedic surgeons.

Results:

Between 40-60% of respondents recommended surgery for (1) patients with minimal or no symptoms, but incidentally discovered increased T2 signal within the cervical cord on MRI, (2) patients with mild symptoms and indentation of the cervical cord but without increased T2 signal and (3) those with at least moderately severe clinical findings accompanied by MRI showing effacement of the thecal sac but without indentation of the cord or increased T2 signal. The severity of the radiological abnormalities most strongly influence treatment decisions.

Conclusion:

We conclude that clinical equipoise does exist for certain groups of patients with CSM, suggesting that a randomized controlled trial could be performed in this population.

Résumé:

RÉSUMÉ: Objectif:

Le principal objectif de cette étude était d'évaluer l'attitude des cliniciens concernant le traitement de la myélopathie cervico-arthrosique (MCA) afin d'établir s'il existe un équilibre clinique pour une partie de cette population de patients. L'objectif secondaire était d'examiner les facteurs qui influencent la décision de traitement.

Méthodes:

Il s'agit d'une enquête transversale par Internet auprès des neurologues, des neurochirurgiens et des orthopédistes.

Résultats:

De 40 à 60% des répondants recommandaient la chirurgie: 1) aux patients qui avaient peu ou pas de symptômes, chez qui une augmentation du signal T2 au niveau de la moelle cervicale était une découverte fortuite; 2) aux patients présentant des symptômes légers et une indentation de la moelle cervicale sans augmentation du signal T2; 3) à ceux qui avaient des manifestations cliniques modérément sévères et une IRM démontrant un effacement du sac thécal sans indentation de la moelle ou sans augmentation du signal T2. La sévérité des anomalies radiologiques influence fortement la décision de traitement.

Conclusions:

Nous concluons que l'équilibre clinique existe pour certains groupes de patients atteints de MCA et qu'un essai contrôlé, randomisé, pourrait être fait dans cette population de patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 1 , February 2007 , pp. 47 - 52
Copyright
Copyright © The Canadian Journal of Neurological 2007

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