Surprising Variables That Affect Surgical Approach for Cervical Spondylotic Myelopathy

Surprising Variables That Affect Surgical Approach for Cervical Spondylotic Myelopathy

Cervical spondylosis with cervical myelopathy (also known as cervical spondylotic myelopathy) is an impairment in the functioning of the spinal cord caused by degenerative changes. In cervical spondylotic myelopathy the discs and facet joints in the neck region of the spine degenerate causing pain or stiffness in the neck, tingling, numbness, or weakness in the arms, hands, or fingers, coordination problems and imbalance, and a loss of fine motor skills. There are several treatment options available for cervical spondylotic myelopathy, but, according to a recent study that analyzed national data, doctor’s recommendations are based on surprising factors like gender, private insurance, and race rather than disease presentation or the results of medical assessments.

Cervical Spondylotic MyelopathyThere are several treatment options available for cervical spondylotic myelopathy, but, according to a recent study that analyzed national data, doctor’s recommendations are based on surprising factors like gender, private insurance, and race rather than disease presentation or the results of medical assessments.

Surgery for cervical spondylotic myelopathy can be performed from the front of the body (anterior) or from the back (posterior). In some cases, doctors may make incisions in both the front and the back of the neck. In the anterior approach, a 1 to 2 inch incision is made along the neck crease on the front in a location that corresponds to the vertebrae being treated. Bone spurs, problematic disks, and other soft tissues are then removed through the neck incision at the front of the body. In the posterior approach, the doctor makes the incision on the back of the neck along the midline of the body. Removal of problematic disks, bone spurs, and other soft tissues are removed through this incision at the back of the body.

The decision to use the posterior approach is supposed to be based on medical factors like the presence of a small spinal canal or enlarged and swollen tissues on the back of a patient’s spine. When more than four vertebrae are involved in the problem the posterior approach is recommended over the anterior approach to treatment. And patients with kyphosis (a spine that’s arched forward) often require a combined anterior-posterior method. But despite these facts, studies have shown that treatment for cervical spondylotic myelopathy is based on demographic variables, not medical ones.

 

Researchers used the Nationwide Inpatient Sample to retrospectively analyze patients who underwent a cervical spondylotic myelopathy treatment between 2001 and 2011. Variables such as patients’ age, sex, race, median household income, and primary payer were analyzed to look for patterns in terms of surgical approach. The study showed that doctors predictably used posterior-only cervical spondylotic myelopathy treatment approaches when patients were of a non-white race and held non-private insurance. Older patients were also more likely to receive a posterior-only treatment. On the other hand, white women with private insurance were most likely to receive an anterior-only approach to treatment. Admission to a non-trauma center was also more likely to result in an anterior-only approach. Hispanics were more likely to receive an anterior-posterior approach and Native Americans were less likely than other groups to receive an anterior-posterior approach.

Older patients were also more likely to receive a posterior-only treatment. On the other hand, white women with private insurance were most likely to receive an anterior-only approach to treatment. Admission to a non-trauma center was also more likely to result in an anterior-only approach. Hispanics were more likely to receive an anterior-posterior approach and Native Americans were less likely than other groups to receive an anterior-posterior approach.

The goal of surgery for cervical spondylotic myelopathy is to decompress the spine and relieve symptoms by getting rid of pressure on the spinal cord. Treatment approaches involve removing pieces of bone or herniated disks or other soft tissues that take up space in the cervical region of the spine. Spinal fusion may also be used to stabilize the spine. By creating more space for the spinal cord inside the spinal column, a pressure is relieved and the pain diminishes. Fusing the vertebrae together stabilizes the area to prevent future problems from developing.



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