Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review
Bibliographic record
Abstract
Title: Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review \n \nAuthors: Lindsay Tetreault1, Mohammed Shamji1, John Rhee2, Heidi Prather3, Jeff Wilson1, Ian B. Andersson4, Anna H. Dembek4, Krystle Pagarigan5, Joseph R. Dettori5, Michael G. Fehlings1 \n \nAffiliations: 1. Toronto Western Hospital, Toronto 2. Emory clinic, Atlanta 3. School of Medicine, Washington University at St. Louis 4. School of Physical Therapy, University of Puget Sound 5. Spectrum Research, Tacoma\nPurpose: To perform a systematic review of the current literature to analyze (1) the change in pain, function, and quality of life resulting from structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) the variability of change in function, pain and quality of life after different nonoperative treatments; (3) the differences in outcomes observed among subgroups (i.e baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from physical therapy intervention.\nMaterials and Methods: A systematic search was conducted in Embase, the Cochrane Collaboration, and PubMed for research published between January 1, 1950 and February 9, 2015. Articles were included if they evaluated outcomes related to structured nonoperative treatment, including manual therapy, therapeutic exercise, cervical bracing and/or traction. Outcomes of interest include functional status (Japanese Orthopedic Association (JOA), Nurick), upper extremity and neck pain, quality of life (Neck Disability Index), and/or surgical intervention. The quality of each study was assessed using the Newcaste-Ottawa Scale and the strength of evidence was rated using guidelines from the Grading of Recommendation Assessment, Development and Evaluation Working Group.\nResults: Of the 570 citations, eight met the criteria for inclusion in this review. There is very low evidence implying that structured nonoperative treatment for DCM garners a positive or negative change in pain, function, and quality of life as interpreted by the JOA score. There is also limited evidence from three studies showing that early nonoperative treatment (symptoms <1 year) is associated with positive clinical outcomes. No studies directly compared structured nonoperative treatment types nor explored outcomes based on patient subgroups. The incidence of conversion to surgery ranged from 23-54%; primarily involving cases of mild or moderate myelopathy (JOA≥12).\nConclusion: There is a general lack of evidence to discern the role of nonoperative treatment for patients with DCM. In the majority of studies, however, patients did not achieve clinically significant gains in functional status with structured nonoperative treatment. Rates of failed conservative treatment among all included studies were between 23-54%.\nClinical Relevance: The role of structured nonoperative treatment for the management of DCM is not well defined, and the typical recommendation for patients with moderate to severe DCM is surgical intervention.\nReferences: Fehlings MG, Ibrahim A, Tetreault L, et al. A Global Perspective on the Outcomes of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results from the Prospective Multicenter AOSpine International Study on 479 patients. Spine. 2015. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain : a journal of neurology. 1972;95(1):101-108. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine. 2015;40(12):E675-693. \nKey Words: cervical myelopathy, degenerative myelopathy, nonsurgical management, nonoperative, conservative, physical therapy, manual therapy, therapeutic exercise, cervical traction, OPLL, spondylotic myelopathy, cervical stenosis
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".