The Natural History of Degenerative Cervical Myelopathy

Abstract

Degenerative cervical myelopathy (DCM) is the most frequent cause of spinal cord dysfunction and injury in the adult population and leads to significant loss of quality of life and economic impact from its associated medical care expenditures and loss of work. Surgical intervention is recommended for patients manifesting progressing neurological signs and symptoms of myelopathy, but the optimal management in individuals who have mild and clinically stable disease manifestations is controversial. Understanding the natural history of DCM is, thus, important in assessing patients and identifying those most appropriately indicated for surgical management. Despite the attempts to rigorously perform studies of the natural history of these patients, most published investigations suffer from methodological weaknesses or are underpowered to provide definitive answers. Investigations of particular patient subsets, however, provide some clinical guidance as to which patients stand most to benefit from surgery, and these may include those with lower baseline mJOA scores, evidence of segmental hypermobility, cord signal changes on MRI, abnormal somatosensory or motor-evoked potentials, or the presence of certain inflammatory markers. Clinicians should assess patients with mild myelopathy and those harboring asymptomatic cervical spinal cord compression individually when making treatment decisions and an understanding of the various factors that may influence natural history may aid in identifying those best indicated for surgery. Further investigations will likely identify how variables that affect natural history can be used in devising more precise treatment algorithms.

A Retrospective Study of Degenerative Cervical Myelopathy and the Surgical Management Within Northern Ireland

“…Degenerative cervical myelopathy (DCM), also known as cervical spondylotic myelopathy (CSM), is the most common cause of non-traumatic spinal cord dysfunction in the ageing population [1]. It is caused by the progressive narrowing of the spinal canal in the cervical region usually, but not solely, due to age-related degenerative changes.…”

Intraoperative ultrasound combined with MRI for evaluating float back and enlargement of the spinal cord after cervical laminoplasty in the management of degenerative cervical myelopathy

“…Degenerative cervical myelopathy (DCM), previously referred to as cervical spondylosis myelopathy [1,2], is a spinal condition that results in chronic, nontraumatic compression of the cervical spinal cord. It is the leading cause of spinal cord dysfunction among adults worldwide [3,4]. This clinicopathologic entity encompasses osteoarthritic degeneration and ligamentous aberrations [5].…”

Is Cervical Disk Arthroplasty a Suitable Alternative to Treat Degenerative Cervical Myelopathy?

“…Surgical management is indicated in individuals in whom there is moderate or severe disease and in those exhibiting progression of neurological symptoms. 1 The earliest method of surgical intervention consisted of laminectomy without fusion or instrumentation. Clinical outcomes, however, were found to be suboptimal, as many patients experienced pain and disability from the development of kyphotic deformity as well as neurological deterioration from inadequate decompression or intraoperative cord injury.…”

“…Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in adults, and it is a major cause of disability and reduction in quality of life in older individuals. Surgical management is indicated in individuals in whom there is moderate or severe disease and in those exhibiting progression of neurological symptoms 1 . The earliest method of surgical intervention consisted of laminectomy without fusion or instrumentation.…”