Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Conclusions
  • References
• 1. Introduction
  • 1.1. Background
  • 1.2. Management of Cervical Degenerative Disease
  • 1.3. Purpose and Scope of the Review
• 2. Methods
  • 2.1. Systematic Review Design Process
  • 2.2. Study Selection
  • 2.3. Risk of Bias Assessment of Individual Studies
  • 2.4. Data Analysis and Synthesis
  • 2.5. Grading the Strength of the Body of Evidence
  • 2.6. Peer Review and Public Commentary
• 3. Results
  • 3.1. Description of Included Studies
  • 3.2. Key Question 1: In patients with radiographic spinal cord compression and no cervical spondylotic myelopathy, what are the comparative effectiveness and harms of surgery compared to non-operative treatment or no treatment?
  • 3.3. Key Question 2: In patients with radiographic spinal cord compression and mild to severe myelopathy, what are the effectiveness and harms of surgery versus non-operative treatment or no treatment? How do the effectiveness and harms vary by level of severity of myelopathy at the time of surgery?
  • 3.4. Key Question 3: In patients with cervical degenerative disease, what are the comparative effectiveness and harms of surgical compared to non-operative treatment?
  • 3.5. Key Question 4:. In patients with cervical degenerative disease, what are the comparative effectiveness and harms of therapies added on to surgery (pre- or post-operative) compared with the same surgery alone?
  • 3.6. Key Question 5: In patients with cervical radiculopathy due to cervical degenerative disease, what are the comparative effectiveness and harms of posterior versus anterior surgery?
  • 3.7. Key Question 6: In patients with cervical degenerative disease, what are the comparative effectiveness and harms of posterior versus anterior surgery in patients with greater than or equal to three level disease?
  • 3.8. Key Question 7: In patients with cervical spondylotic myelopathy due to cervical degenerative disease, what are the comparative effectiveness and harms of cervical laminectomy and fusion compared to cervical laminoplasty?
  • 3.9. Key Question 8:. In patients with cervical spondylotic radiculopathy or myelopathy at one or two levels, what are the comparative effectiveness and harms of cervical arthroplasty compared to anterior cervical discectomy and fusion?
  • 3.10. Key Question 9: In patients undergoing anterior cervical discectomy and fusion, what are the comparative effectiveness and harms of surgery based on interbody graft material or device type?
  • 3.11. Key Question 10: In patients with pseudarthrosis after prior anterior cervical fusion surgery, what are the comparative effectiveness and harms of posterior approaches compared to revision anterior arthrodesis?
  • 3.12. Key Question 11: In patients with cervical spondylotic myelopathy, what is the prognostic utility of preoperative magnetic resonance imaging (MRI) findings for neurologic recovery after surgery?
  • 3.13. Key Question 12: What are the sensitivity and specificity of imaging assessment for identifying symptomatic pseudarthrosis after prior cervical fusion surgery?
  • 3.14. Key Question 13: In patients with cervical spondylotic myelopathy, what are the comparative effectiveness and harms of intraoperative neuromonitoring (e.g., with somatosensory or motor evoked potential measurements) versus no neuromonitoring on clinical outcomes in patients undergoing surgery?
  • 3.15. Contextual Question 1: What is the prevalence of cervical degenerative disease with spinal cord compression in asymptomatic patients?
  • 3.16. Contextual Question 2: What is the natural history of untreated spinal cord compression in patients with cervical degenerative disease?
• 4. Discussion
  • 4.1. Findings in Relation to the Decisional Dilemmas
  • 4.2. Implications for Clinical and Policy Decisions
  • 4.3. Strength and Limitations of the Systematic Review Process
  • 4.4. Applicability
  • 4.5. Future Research
  • 4.6. Conclusions
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A. Methods
  • Appendix B. Included Studies
  • Appendix C. Evidence Tables
  • Appendix D. Risk of Bias Assessment
  • Appendix E. List of Excluded Studies
  • Appendix F. Meta-Analysis
  • Appendix G. Strength of Evidence
  • Appendix H. Appendix References

Suggested citation:

Selph SS, Skelly AC, Jungbauer RM, Brodt E, Blazina I, Philipp TC, Mauer KM, Dettori J, Atchison C, Riopelle D, Stabler-Morris S, Fu R, Yu Y, Chou R. Cervical Degenerative Disease Treatment: A Systematic Review. Comparative Effectiveness Review No. 266. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 24-EHC001. Rockville, MD: Agency for Healthcare Research and Quality; November 2023. DOI: https://doi.org/10.23970/AHRQEPCCER266. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00006). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

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AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Cervical Degenerative Disease Treatment: A Systematic Review, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).