Tolerance for Adverse Events from Operative and Nonoperative Treatment for Mild Cervical Spondylotic Myelopathy

In a randomized vignette experiment of 263 U.S. adults with mild cervical spondylotic myelopathy, dominant decision factors ranged from 13.5% to 87.8%, driven mainly by adverse-event permanence.

• Why it matters: Guidelines allow either surgery or nonoperative care for mild disease, but how people trade off adverse events across pathways is not well quantified.
• What they did: Participants (age 40+) read identical mild CSM descriptions and were randomized to surgery with symptom improvement, surgery halting progression, or nonoperative management with symptom progression, then rated decision influence (0–10) and whether they would still choose the same treatment.
• The result: Persisting adverse events at one year produced higher dominant-factor rates than the same events resolving by three months; in nonoperative care, worsening bladder control (56.6%) and neck pain disrupting sleep (53.0%) were strongest.

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