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M
anagement
of
degenerative
cervical
myelopathy
– A
n
update
R
ev
A
ssoc
M
ed
B
ras
2016; 62(9):886-894
893
diagnosis is made clinically and confirmed with a cervical
MRI. The severity of the DCM can be objectively assessed
using the mJOA and the Nürick scale, the most com-
monly used scoring for cervical myelopathy.
Surgical treatment is the main treatment modality.
The main goals of surgery are to decompress the spinal
cord, maintain stability and achieve a good cervical align-
ment with an anticipated outcome of neurological pres-
ervation or improvement. The choice of one approach
over the other depends on patient’s characteristics (such
as number of involved levels, site of compression, cervical
alignment, previous surgeries, bone quality, presence of
instability, among others) and surgeon’s preference.
Spine surgeons must understand the advantages and
disadvantages of all surgical techniques to choose the
best surgery for each patient to optimize the final outcome.
Further comparative studies are necessary to attest the
superiority and differential risks of one approach over
the other when multiple options are available.
No funds were received in support of this study. No
benefits in any form have been or will be received from a
commercial party directly or indirectly related to the sub-
ject of this manuscript. The authors have no financial
interest in the subject of this article. The manuscript
submitted does not contain information about medical
device(s).
R
esumo
Manejo da mielopatia cervical degeneratiiva – Uma
atualização
Introdução:
a mielopatia cervical degenerativa (MCD) é
uma das causas mais comuns de disfunção medular em
adultos. Os pacientes em geral apresentam declínio neu-
rológico lento e progressivo, ou deterioração escalonada.
No presente artigo, discutimos os mais importantes fatores
envolvidos no manejo da MCD, incluindo considerações
sobre os aspectos relacionados à escolha da abordagem
cirúrgica.
Método:
realizou-se extensa revisão da literatura de arti-
gos
peer-reviewed
relacionados ao tema.
Resultados:
embora o diagnóstico seja realizado clinica-
mente, a ressonância magnética (RM) é o estudo de ima-
gem de escolha para confirmá-lo e excluir eventuais diag-
nósticos diferenciais. A gravidade do quadro clínico pode
ser avaliado utilizando-se diferentes escalas, como a
modified Japanese Orthopedic Association (mJOA) ou a
de Nürick, provavelmente as mais comuns. Uma vez que
a melhora clínica espontânea é rara, a cirurgia é a princi-
pal forma de tratamento, em uma tentativa de evitar dano
neurológico adicional ou deterioração e, potencialmente,
aliviar alguns sintomas e melhorar a função dos pacientes.
Abordagens cirúrgicas por via anterior, posterior ou com-
binada podem ser usadas para descomprimir o canal,
concomitantemente a técnicas de fusão. A escolha da
abordagem depende das características dos pacientes
(número de segmentos envolvidos, local de compressão,
alinhamento cervical, cirurgias prévias, qualidade óssea,
presença de instabilidade, entre outras), além da prefer-
ência e experiência do cirurgião.
Conclusão:
os cirurgiões de coluna devem compreender
as vantagens e desvantagens de todas as técnicas cirúrgi-
cas para escolher o melhor procedimento para seus paci-
entes. Estudos futuros comparando as abordagens são
necessários para orientar o cirurgião quando múltiplas
opções forem possíveis.
Palavras-chave:
mielopatia cervical, mielopatia es-
pondilótica, abordagem cirúrgica, abordagem anterior,
abordagem posterior.
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