Abstracts & Literature Review 1

Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

Murphy DR, Coulis CM, Gerrard JK
Chiropractic & Osteopathy. 2009, 17:8.
© 2007 Chiropractic and Osteopathy

JACO Editorial Reviewer: Anthony V. D’Antoni, MS, DC, PhD

Published: December, 2009
Journal of the Academy of Chiropractic Orthopedists
December 2009, Volume 6, Issue 4
Received: September 2009
Accepted: September 2009

The original article copyright belong s to the original publisher. This review is available from: http://www.dcorthoacademy.com © 2009 D’Antoni and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

JACO Editorial Summary

• The authors of this qualitative systematic review investigated whether the scientific evidence supports or refutes the recommendation that decompression surgery should be done in patients with spondylolytic encroachment on the cervical spinal cord without myelopathy to prevent future spinal cord injury due to minor trauma. There is a paucity of studies on the efficacy of surgery to prevent prospective outcomes. This paper is an excellent example of how a dilemma in clinical practice (ie, how best to advise patients about the risks and benefits of preventive surgery) drove the authors to conduct a systematic review. Consequently, this paper should be very useful to both surgical and non-surgical spine clinicians in clinical practice.
• Out of 1881 citations, the authors retained two papers that met their inclusion criteria. In the abstract under Results, it was written that three papers were retrieved when, in fact, there were only two retrieved. Although the design of both papers was at the lower end of the evidence-based spectrum, the authors acknowledged that more robust studies (such as cohort and case-control studies) are needed to investigate their research questions. Consequently, this study has identified a major gap in the literature.
• The authors concluded that a recommendation for prophylactic decompression surgery in asymptomatic patients is not warranted at this time based on the available evidence. However, keeping with the tenets of evidence-based medicine, the authors remind the readers that clinical decisions should ultimately incorporate evidence with clinical experience and patient values.
• From a conservative viewpoint, spine surgery should only be used when conservative interventions fail or the patient is a risk for immediate catastrophic neurologic deficit. One must always consider if the benefits of surgery outweigh the risks. Clearly, the literature does not currently support the use of surgery in these patients. As the authors point out, even surgeons have mixed views on the appropriateness of this preventive surgery. The bottom line is clinicians should cautiously advise their patients using these data, and suggest a second surgical opinion for patients convinced that this surgery will be beneficial for them.