American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate treatment for degenerative cervical spondylotic myelopathy in patients without contraindications?

1. Physical therapy

2. Surgical decompression

3. Medication management

4. Observation and monitoring

The correct answer is: Surgical decompression

Surgical decompression is the most appropriate treatment for degenerative cervical spondylotic myelopathy in patients without contraindications because this condition involves compression of the spinal cord due to degenerative changes in the cervical spine. The surgical approach aims to relieve the pressure on the spinal cord, thereby alleviating neurological symptoms and preventing further deterioration of neurological function. Evidence shows that patients with moderate to severe myelopathy experience significant benefits from surgical intervention compared to conservative management options. Surgical decompression can lead to improvements in strength, sensory function, and overall quality of life. In some cases, delaying surgery can result in irreversible changes or worsening of symptoms, making timely surgical intervention critical. Although other options such as physical therapy, medication management, and observation and monitoring may be relevant in specific scenarios, they do not adequately address the underlying issue of spinal cord compression. Physical therapy might help manage symptoms in less severe cases, but it is unlikely to resolve the root cause. Similarly, medication management can provide symptomatic relief but fails to address the structural changes causing the myelopathy. Observation and monitoring may be suitable for asymptomatic individuals or those with mild symptoms, but surgery remains the definitive treatment for those with significant neurological deficits or progressive symptoms.