An Algorithmic Roadmap for Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review.
Academic Article
Overview
abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, with its surgical management being crucial for patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach, as there is no universally correct answer. This narrative review aims to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each situation. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤ 3 levels, (2) K-line (+) and ≥ 3 levels, (3) K-line (-) and ≤ 3 levels, and (4) K-line (-) and ≥ 3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical levels and K-line status. The complexity of surgical situations and the diversity of treatment methods for DCM can be effectively managed by utilizing an algorithmic approach. Furthermore, surgical techniques that minimize stages and address challenging conditions could potentially enhance outcomes in DCM treatment.
