AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy.

Journal: Global spine journal
Published Date: Apr 21, 2025

Abstract

Study DesignLiterature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations.ObjectiveThis article summarizes several key current topics related to the management of DCM.MethodsRecent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional.ResultsArticle 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients.ConclusionsDCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles.

Authors

  • Michael G Fehlings
    Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Nathan Evaniew
    Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
  • Paula Valerie Ter Wengel
    Department of Neurosurgery, Haaglanden Medical Center, Hague, the Netherlands.
  • Aditya Vedantam
    Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Daipayan Guha
    Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
  • Konstantinos Margetis
    Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA.
  • Aria Nouri
    Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
  • Aminul I Ahmed
    Wolfson SPaRC, King's College London, London, UK.
  • Chris J Neal
    Division of Neurosurgery, Maine Medical Center, Portland, ME, USA.
  • Benjamin M Davies
    Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
  • Mario Ganau
    Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
  • Jefferson R Wilson
    Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
  • Allan R Martin
    Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Lukas Grassner
    Department of Neurosurgery, Christian Doppler Clinic. Paracelsus Medical University, Salzburg, Austria.
  • Lindsay Tetreault
    NYU Langone Health, New York, USA.
  • Vafa Rahimi-Movaghar
    Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Rex Marco
    UT Health Houston McGovern Medical School, Houston, TX, USA.
  • James Harrop
    Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
  • James Guest
    University of Miami, Miami, FL, USA.
  • Mohammed Ali Alvi
    Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
  • Karlo M Pedro
    Division of Neurosurgery & Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
  • Brian K Kwon
    The University of British Columbia, Vancouver, BC, Canada.
  • Charles G Fisher
    Division of Spine Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
  • Shekar N Kurpad
    Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.

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