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Supplemental: Chiari I Malformation (CM)

This report is from the Cervical Radiculopathy from Degenerative Disorders Work Group of the NASS' Evidence-Based Clinical Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. Each member of the group formatted a series of clinical questions to be addressed by the group. The final questions agreed on by the group are the subjects of this report. A literature search addressing each question using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional evidence-based databases. The relevant literature was then independently rated by a minimum of three reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were arrived at via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.  

 

Results: Eighteen clinical questions were formulated, addressing issues of natural history, diagnosis, and treatment of cervical radiculopathy from degenerative disorders. The answers are summarized in this article. The respective recommendations were graded by the strength of the supporting literature, which was stratified by levels of evidence.  

 

A clinical guideline for cervical radiculopathy from degenerative disorders has been created using the techniques of evidence-based medicine and best available evidence to aid both practitioners and patients involved with the care of this condition (Bono, et al., 2011).

This is a well-researched guideline system with wide applicability for spine disorders.

 

A recognized shortcoming of symptom questionnaires is that their numerical scores lack a direct, clinically significant meaning. The Health Transition Index (HTI) along with the along with the NASS Satisfaction Questionnnaire used to determine a patient's satisfaction with surgery can be used to define a minimally clinically significant important difference (MCID).

 

The MCID threshold is defined as the lower limit of the 95% confidence interval (CI) for the median change score of each other outcome metrics for the patients classified as responders based on each anchor (NASS satisfaction and HTI). Additionally, the probability that scores will correctly discriminate between responders and nonresponders (accuracy) can be depicted by the area under the receiver-operating characteristic (ROC) curve. This value ranges from 0.5 (discrimination is no better than pure chance) to 1.0 (all patients are able to be correctly discriminated). An area of 0.7 to 0.8 is considered adequate; an area of 0.8 to 0.9 is considered excellent (Copay et al., 2007).