American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients over 65 years with compressive cervical spondylotic myelopathy, what is the treatment recommendation?

1. Increased physical activity

2. Surgical decompression is appropriate

3. Conservative management only

4. Follow-up with imaging studies

The correct answer is: Surgical decompression is appropriate

Surgical decompression is the recommended treatment for patients over 65 years with compressive cervical spondylotic myelopathy due to the potential for significant neurological impairment and quality of life issues associated with this condition. In elderly patients, the progression of myelopathy can lead to worsening motor function, balance issues, and increased risk of falls, which can significantly impact daily living. Surgical intervention aims to relieve the spinal cord compression and prevent further neurological deterioration. Various surgical techniques, such as anterior cervical discectomy and fusion or laminectomy, can be utilized depending on the specific anatomical considerations and severity of the myelopathy. Although conservative management can be appropriate for certain other spinal conditions or less severe cases, the presence of compression and the symptoms associated with cervical spondylotic myelopathy generally warrant surgical consideration in this age group. Increased physical activity and conservative management alone may not adequately address the neurological deficits and quality of life concerns, making surgery the more effective choice. Follow-up with imaging studies could be useful for monitoring, but it does not constitute a standalone treatment option for symptomatic patients who are likely to benefit from surgical intervention.