Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]

Nouri A, Tessitore E, Molliqaj G, Meling T, Schaller K, Nakashima H, Yukawa Y, Bednarik J, Martin AR, Vajkoczy P, Cheng JS, Kwon BK, Kurpad SN, Fehlings MG,
Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Davies BM, Kotter MRN, Wilson JR.

Global Spine J. 2022 Feb;12(1_suppl):39S-54S. doi: 10.1177/21925682211036071. PMID: 35174726; PMCID:PMC8859703.

16 May 2022

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Study design: Narrative review.

Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).

Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.

Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years.

Conclusion: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

Keywords: cervical spondylotic myelopathy (CSM); cord compression; ossification of the posterior longitudinal ligament (OPLL); progression; risk factors.

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