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Chiropractic Research Review

Early Research on the Outcomes of Conservative Treatment for Mild Cervical Myelopathy

Conservative treatments are commonly used on patients with lumbar disc herniation with good results; however, few reports address the conservative treatment of cervical soft disc herniation (CDH), especially in patients exhibiting myelopathy associated with CDH.

Conservative care for CDH with symptoms of radiculopathy are reported, but conservative care for patients with myelopathy is thought to be risky because of the concern that irreversible deterioration of the neurological effects will occur. For patients with CDH and myelopathy, surgical intervention is typically involved. The authors of this paper investigated the outcomes of conservative care on CDH and myelopathy patients in order to see if some surgeries may be prevented. This study also sought to evaluate the usefulness of magnetic resonance imaging (MRI) in predicting treatment outcomes.

Patients with CDH and myelopathy were evaluated using the Japanese Orthopedic Association (JOA) criteria for evaluation of cervical myelopathy. Each patient was also examined using MRI. Patients with a JOA score of 10 or more were provided conservative care, representing less-serious myelopathy. Patients with scores of less than 10 were not given conservative care. Conservative care of 27 patients included the use of cervical bracing with a collar and mandibular support. Collars were worn 8 hours each day during the first three months. Then, time spent in the collar was reduced, depending on the patient's symptomatology. Restriction of daily activities was also recommended.

Results: Of the 27 patients in the study, 10 eventually needed decompression surgery due to neurologic deterioration, while 17 were given only conservative treatments. Follow-up MRI scans showed that 59% of the conservative group had "spontaneous regression of the herniated mass," and 63% of the patients were considered effectively treated. Regression of the CDH was observed in 37% of patients with focal-type herniation and 78% with diffuse-type herniation.

The authors conclude, "A good outcome can be expected in patients with a median-type and/ or diffuse-type herniation on magnetic resonance imaging."

The authors note shortcomings to consider when managing myelopathy with conservative care: the optimal timing for decompression surgery may be missed, and some patients may remain disabled by myelopathy.

Matsumoto M, Chiba K, Ishikawa M, et al. Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations. Spine July 15, 2001: 26(14), pp. 1592-1598.

Chiropractic Research Review

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