A systematic review and meta-analysis compare surgical treatment and conservative treatment in patients with cervical spondylotic myelopathy.

Abstract

Cervical spondylotic myelopathy (CSM) can be managed by conservative treatment or surgical treatment. This study aimed to compare the clinical effects of conservative treatment versus surgical treatment for patients with CSM. Reports of randomized controlled trials and retrospective cohort studies that compared surgical treatment versus conservative treatment for CSM were collated from medical databases. The following data were extracted from eligible studies: pre- and post-treatment Japanese Orthopedic Association (JOA) scores, recovery rate, American Spinal Injury Association (ASIA) scores, and ASIA grade change. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). A total of 10 studies were included in this meta-analysis, with a total of 517 patients. Patients who received surgical treatment had lower pre-treatment JOA scores compared to patients who received conservative treatment (P=0.01). However, there was no difference in the post-treatment JOA scores between the two types of treatment (P=0.70). This demonstrated that the increase in JOA score was greater in the surgical group compared to the conservative group. Additionally, patients in the surgical group had a higher recovery rate than patients in the conservative group (P<0.00001). Although this investigation showed no significant difference in ASIA score between the two groups (P=0.30), there was a definite difference in ASIA grade change after sensitivity analysis. This meta-analysis suggested that surgical treatment may be more advantageous than conservative treatment in patients with CSM. However, these findings should be verified with larger, multi-centered, follow-up, controlled trials.