Degenerative Cervical Myelopathy: Towards a Personalized Approach

Abstract

Degenerative cervical myelopathy (DCM) is a recently coined term encompassing a variety of age-related and genetically associated pathologies, including cervical spondylotic myelopathy, degenerative disc disease, and ligamentous aberrations such as ossification of the posterior longitudinal ligament. All of these pathologies produce chronic compression of the spinal cord causing a clinical syndrome characterized by decreased hand dexterity, gait imbalance, and potential genitourinary or sensorimotor disturbances. Substantial variability in the underlying etiology of DCM and its natural history has generated heterogeneity in practice patterns. Ongoing debates in DCM management most commonly center around clinical decision-making, timing of intervention, and the ideal surgical approach. Pivotal basic science studies during the past two decades have deepened our understanding of the pathophysiologic mechanisms surrounding DCM. Growing knowledge of the key pathophysiologic processes will help us tailor personalized approaches in an increasingly heterogeneous patient population. This article focuses on summarizing the most exciting approaches in personalizing DCM patient treatments including biomarkers, factors affecting clinical decision-making, and choice of the optimal surgical approach. Throughout we provide a concise review on the conditions encompassing DCM and discuss the underlying pathophysiology of chronic spinal cord compression. We also provide an overview on clinical-radiologic diagnostic modalities as well as operative and nonoperative treatment strategies, thereby addressing knowledge gaps and controversies in the field of DCM.

Current Trends in Degenerative Cervical Myelopathy

“…With a personalized approach, treatment outcomes can be enhanced in all the cases. The operative approach, pre-and post-operative care can be personalized and optimized for achieving favorable patient outcomes [65]. An extensive population of a country like ours will need care at decreased costs, which would thus affect the innovation in our specialty.…”

Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms

“…Patients with DCM present a broad spectrum of symptoms, ranging from subtle sensory neuropathic symptoms to motor weakness with functional disability, depending on disease progression and severity ( 2 ). Patients with DCM require early diagnosis and management; specifically, it is essential to determine an appropriate therapeutic option according to the disease severity while minimizing damage to the spinal cord ( 3 , 4 ).…”

Elderly Patients Show Substantial Improvement in Health-Related Quality of Life After Surgery for Degenerative Cervical Myelopathy Despite Medical Frailty: An Ambispective Analysis of a Multicenter, International Data Set

“…Comorbidities in this population require personalized approaches considering frailty. 5,6 Studies have shown that frailty, particularly measured by mFI-5, is more predictive than age in patients with DCM in predicting adverse events, hospital stay, and discharge. 7 Although various frailty measures exist, mFI-5 and mFI-11 are the most suitable, offering generalizability, objectivity, and high reproducibility.…”