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.
Authors
Affiliations (22)
Affiliations (22)
- Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada.
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
- Department of Neurosurgery, Haaglanden Medical Center, Hague, the Netherlands.
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- The Mount Sinai Hospital, New York, NY, USA.
- Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
- Wolfson SPaRC, King's College London, London, UK.
- Division of Neurosurgery, Maine Medical Center, Portland, ME, USA.
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- University of California Davis, Davis, CA, USA.
- Department of Neurosurgery, Christian Doppler Clinic. Paracelsus Medical University, Salzburg, Austria.
- NYU Langone Health, New York, USA.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- UT Health Houston McGovern Medical School, Houston, TX, USA.
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
- University of Miami, Miami, FL, USA.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- The University of British Columbia, Vancouver, BC, Canada.
- Division of Spine Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
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. <b>Conditional</b> 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. <b>Conditional</b> 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. <b>Strong</b> 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. <b>Conditional</b> 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.