Decompressive surgery for asymptomatic severe cervical spondylosis
Patients without overt neurological symptoms or signs may be considered for surgery before they develop neurological abnormalities, following the concept that early, aggressive treatment may prevent neurological complications (although the risk of such neurological complications is very low i.e., <0.1%). For example, patients may experience severe myelopathy even with minor trauma due to the pre-existing stenosis. An early procedure may prevent this from occurring. Conversely, many patients are asymptomatic. There are no studies of the natural history of the disease to suggest what proportion may become symptomatic, whereas all surgery has known immediate risks and some loss of mechanical function of the cervical spine. Because there are no available data on the likelihood of an asymptomatic patient spontaneously developing cervical myelopathy over time, the consensus at this time is that surgical risks typically outweigh the spontaneous risk of developing neurological compromise in most asymptomatic patients.
Joint replacement of the cervical spine is now FDA approved in the US for use in anterior cervical procedures for cervical radiculopathy. However, parallel to lumbar arthroplasty and anterior lumbar interbody fusion, these devices may also be effective in treating axial neck pain that can be attributed to cervical degenerative disc disease. Results from two 7-year follow-up studies of randomised controlled trials show superiority in neck disability outcome with arthroplasty, and reduced secondary operations with arthroplasty compared with anterior cervical discectomy and fusion procedures.
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