Review

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

Donald R Murphy^1,2,3 , Christopher M Coulis^4,5 and Jonathan K Gerrard⁶

¹  Rhode Island Spine Center, 600 Pawtucket Ave, Pawtucket, RI 02860-6059, USA

²  Department of Community Health, Alpert Medical School of Brown University, Box G-A, Providence, RI 02912, USA

³  Department of Research, New York Chiropractic College, 2360 State Rte. 89, Seneca Falls, New York 13148, USA

⁴  Shoreline Spine & Pain Associates, PC, 2415 Boston Post Rd, Guilford, CT 06437, USA

⁵  Clinical Sciences, University of Bridgeport, College of Chiropractic,126 Park Avenue, Bridgeport, CT 06604, USA

⁶  Aquarius Chiropractic, #210-179 Davie Street Vancouver, V6Z 2Y1, USA

author email corresponding author email

Chiropractic & Osteopathy 2009, 17:8doi:10.1186/1746-1340-17-8

Published:	24 August 2009

Abstract

Background

It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery.

Methods

A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery.

Results

Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%.

Conclusion

There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made. Recommendations to individual patients must consider possible unique circumstances.