scholarly journals Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions

2020 ◽  
Vol 9 (2) ◽  
pp. 535 ◽  
Author(s):  
Aria Nouri ◽  
Joseph S. Cheng ◽  
Benjamin Davies ◽  
Mark Kotter ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
The Elderly ◽  
Developed Countries ◽  
Intervertebral Discs ◽  
Neurological Dysfunction ◽  
Tremendous Progress ◽  
Cord Injury ◽  
Negative Impacts ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in developed countries; its prevalence is increasing due to the ageing of the population. DCM causes neurological dysfunction and is a significant cause of disability in the elderly. It has important negative impacts on the quality of life of those affected, as well as on their caregivers. DCM is triggered by a variety of degenerative changes in the neck, which affect one or more anatomical structures, including intervertebral discs, vertebrae, and spinal canal ligaments. These changes can also lead to structural abnormalities, leading to alterations in alignment, mobility, and stability. The principle unifying problem in this disease, regardless of the types of changes present, is injury to the spinal cord due to compression by static and/or dynamic forces. This review is partitioned into three segments that focus on key elements of the past, the present, and the future in the field, which serve to introduce the focus issue on “Degenerative Cervical Myelopathy and the Aging Spine”. Emerging from this review is that tremendous progress has been made in the field, particularly in recent years, and that there are exciting possibilities for further advancements of patient care.

scholarly journals The Natural History of Degenerative Cervical Myelopathy and the Rate of Hospitalization Following Spinal Cord Injury: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 28S-34S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
Spyridon Karadimas ◽  
Jefferson R. Wilson ◽  
Paul M. Arnold ◽  
Shekar Kurpad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Cervical Myelopathy ◽  
Cochrane Collaboration ◽  
Level Of Evidence ◽  
Cord Injury ◽  
History Of ◽  
Degenerative Cervical Myelopathy

Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low.

Cervical Myelopathy

2018 ◽  
pp. 71-80
Author(s):  
Mario Ganau ◽  
So Kato ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Deformity Correction ◽  
Kyphotic Deformity ◽  
Surgical Team ◽  
Comprehensive Management ◽  
Cord Injury ◽  
Pros And Cons ◽  
Spinal Cord Decompression ◽  
Degenerative Cervical Myelopathy

Patients with kyphotic deformity and degenerative cervical myelopathy are at elevated risk for traumatic and nontraumatic spinal cord injury and require comprehensive management entailing a careful clinical assessment with dedicated functional scales and radiological study of spinal balance. Surgical strategies to address this clinical scenario including anterior, posterior, and combined approaches. Whatever the choice, the surgical plan should always envisage spinal cord decompression and stabilization along with deformity correction. The surgical team should discuss pros and cons of the most appropriate surgical plan with the patient, anticipate possible complications, and propose alternate strategies. This chapter details the most important practical aspects of surgical management, ranging from technical advantages of multiple osteotomies and selection of implants for instrumented fusion, to the surgical and anesthesiological nuances to avoid intraoperative and postoperative complications. An overview is provided of scientific literature regarding the correction of kyphotic deformity and ongoing clinical trials.

Prospects of cell replacement therapy for the treatment of degenerative cervical myelopathy

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Graham Ka Hon Shea ◽  
Paul Aarne Koljonen ◽  
Ying Shing Chan ◽  
Kenneth Man Chee Cheung
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Replacement Therapy ◽  
Cervical Myelopathy ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Cell Replacement Therapy ◽  
Cell Replacement ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy

AbstractDegenerative cervical myelopathy (DCM) presents insidiously during middle-age with deterioration in neurological function. It accounts for the most common cause of non-traumatic spinal cord injury in developed countries and disease prevalence is expected to rise with the aging population. Whilst surgery can prevent further deterioration, biological therapies may be required to restore neurological function in advanced disease. Cell replacement therapy has been inordinately focused on treatment of traumatic spinal cord injury yet holds immense promise in DCM. We build upon this thesis by reviewing the pathophysiology of DCM as revealed by cadaveric and molecular studies. Loss of oligodendrocytes and neurons occurs via apoptosis. The tissue microenvironment in DCM prior to end-stage disease is distinct from that following acute trauma, and in many ways more favourable to receiving exogenous cells. We highlight clinical considerations for cell replacement in DCM such as selection of cell type, timing and method of delivery, as well as biological treatment adjuncts. Critically, disease models often fail to mimic features of human pathology. We discuss directions for translational research towards clinical application.

scholarly journals Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History

2021 ◽  
Vol 10 (16) ◽  
pp. 3626
Author(s):  
Melissa Lannon ◽  
Edward Kachur
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Cord Compression ◽  
Upper Extremities ◽  
Medical Practitioners ◽  
Cord Injury ◽  
Neurologic Disability ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord injury and a major contributor to morbidity resulting from narrowing of the spinal canal due to osteoarthritic changes. This narrowing produces chronic spinal cord compression and neurologic disability with a variety of symptoms ranging from mild numbness in the upper extremities to quadriparesis and incontinence. Clinicians from all specialties should be familiar with the early signs and symptoms of this prevalent condition to prevent gradual neurologic compromise through surgical consultation, where appropriate. The purpose of this review is to familiarize medical practitioners with the pathophysiology, common presentations, diagnosis, and management (conservative and surgical) for DCM to develop informed discussions with patients and recognize those in need of early surgical referral to prevent severe neurologic deterioration.

scholarly journals The Role of Vitamin B12 in the Management and Optimization of Treatment in Patients With Degenerative Cervical Myelopathy

2018 ◽  
Vol 9 (3) ◽  
pp. 331-337 ◽  
Author(s):  
Aria Nouri ◽  
Kishan Patel ◽  
Julio Montejo ◽  
Rani Nasser ◽  
David A. Gimbel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Case Reports ◽  
The Elderly ◽  
Future Research ◽  
Vitamin B ◽  
Subacute Combined Degeneration ◽  
High Prevalence ◽  
Degenerative Cervical Myelopathy

Study Design: Narrative review. Objectives: To discuss the relationship between degenerative cervical myelopathy (DCM) and vitamin B12 deficiency. Specifically, it is the aim to outline the rational for future research into assessment and therapeutic optimization of vitamin B12 in the treatment of DCM. Methods: Literature review. Results: DCM is the commonest cause of spinal cord impairment, with an average age of presentation in the sixth decade. Patients at this age have also been reported to have a high prevalence of vitamin B12 deficiency, with estimates of up to 20% in the elderly. Vitamin B12 deficiency can result in subacute combined degeneration of the spinal cord (SACD), and several case reports have pointed to patients with both DCM and SACD. Both SACD and reversible compressive injury due to DCM necessitate remyelination in the spinal cord, a process that requires adequate vitamin B12 levels. Basic science research on nerve crush injuries have shown that vitamin B12 levels are altered after nerve injury and that vitamin B12 along with dexamethasone or nonsteroidal anti-inflammatory drugs can reduce Wallerian degeneration. Furthermore, it has been suggested that a combination of B-vitamins can reduce glutamate-induced neurotoxicity. Conclusions: Given the high prevalence of clinical and subclinical vitamin B12 deficiency in the elderly, the role of vitamin B12 in myelination, and vitamin B12 deficiency as a differential diagnosis of DCM, it is important to investigate what role vitamin B12 levels play in patients with DCM in terms of baseline neurological function and whether optimization of vitamin B12 levels can improve surgical outcome. Furthermore, the routine assessment of vitamin B12 levels in patients considered for DCM surgery should be considered.

scholarly journals Spinal Cord Morphology in Degenerative Cervical Myelopathy Patients; Assessing Key Morphological Characteristics Using Machine Vision Tools

2021 ◽  
Vol 10 (4) ◽  
pp. 892
Author(s):  
Kalum Ost ◽  
W. Bradley Jacobs ◽  
Nathan Evaniew ◽  
Julien Cohen-Adad ◽  
David Anderson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Morphological Characteristics ◽  
Current State ◽  
Cord Injury ◽  
Automated Tools ◽  
Patient Prognosis ◽  
Degenerative Cervical Myelopathy ◽  
Automated Processes ◽  
Automated Methods

Despite Degenerative Cervical Myelopathy (DCM) being the most common form of spinal cord injury, effective methods to evaluate patients for its presence and severity are only starting to appear. Evaluation of patient images, while fast, is often unreliable; the pathology of DCM is complex, and clinicians often have difficulty predicting patient prognosis. Automated tools, such as the Spinal Cord Toolbox (SCT), show promise, but remain in the early stages of development. To evaluate the current state of an SCT automated process, we applied it to MR imaging records from 328 DCM patients, using the modified Japanese Orthopedic Associate scale as a measure of DCM severity. We found that the metrics extracted from these automated methods are insufficient to reliably predict disease severity. Such automated processes showed potential, however, by highlighting trends and barriers which future analyses could, with time, overcome. This, paired with findings from other studies with similar processes, suggests that additional non-imaging metrics could be added to achieve diagnostically relevant predictions. Although modeling techniques such as these are still in their infancy, future models of DCM severity could greatly improve automated clinical diagnosis, communications with patients, and patient outcomes.

scholarly journals Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury

Spinal Cord ◽  
2021 ◽  
Author(s):  
Carl M. Zipser ◽  
Konstantinos Margetis ◽  
Karlo M. Pedro ◽  
Armin Curt ◽  
Michael Fehlings ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Myelopathy ◽  
Cervical Spinal Cord ◽  
Neurological Impairment ◽  
Common Data Elements ◽  
Cord Injury ◽  
Data Elements ◽  
Degenerative Cervical Myelopathy ◽  
Work Up

AbstractDegenerative cervical myelopathy (DCM) is a common non-traumatic spinal cord disorder and characterized by progressive neurological impairment. Generally, it is still underdiagnosed and referral to spine specialists is often late, when patients already present with incomplete cervical spinal cord injury (SCI). To improve early diagnosis and accelerate referral, diagnostic criteria for DCM are required. Recently, AO Spine RECODE- DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) (aospine.org/recode), an international, interdisciplinary and interprofessional initiative, including patients with DCM, was funded with the aim to accelerate knowledge discovery that can change outcomes. In this perspective we advocate for the participation of SCI specialists in this process, where the expertise and perspective on this disorder and requirements for the diagnostic and therapeutic work up is well developed.

scholarly journals Guidelines for the Management of Degenerative Cervical Myelopathy and Spinal Cord Injury: An Introduction to a Focus Issue

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 6S-7S ◽  
Author(s):  
Michael G. Fehlings ◽  
Brian K. Kwon ◽  
Lindsay A. Tetreault
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Myelopathy ◽  
Guideline Development ◽  
Clinical Expertise ◽  
Guideline Development Group ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy ◽  
Development Group

Study Design: Introduction to a guidelines project. Objectives: The objective of this focus issue is to present guidelines that outline how to best manage patients with degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). Topics addressed in this focus issue include: 1) management strategies for patients with mild, moderate and severe DCM; and 2a) timing of surgical decompression; b) the use of methylprednisolone sodium succinate; c) the type and timing of anticoagulation strategies; d) the role of magnetic resonance imaging in clinical decision making and outcome prediction; and e) the type and timing of rehabilitation in patients with SCI. Methods: Systematic reviews were conducted to address key clinical questions and to synthesize the current body of evidence. A multidisciplinary guideline development group used the results of these reviews, along with their clinical expertise, to develop clinical practice guidelines, in a process that adhered to methodology proposed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group. Results: The multidisciplinary guideline development group combined the systematic review findings with their clinical expertise and opinions to formulate recommendations on how to manage patients with DCM and SCI. Conclusions: These guidelines will serve as tools to assist clinicians in their decision making by offering a perspective that combines the available evidence, expertise from a variety of clinicians, and patient values.

scholarly journals Nonoperative Versus Operative Management for the Treatment Degenerative Cervical Myelopathy: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 35S-41S ◽  
Author(s):  
John Rhee ◽  
Lindsay A. Tetreault ◽  
Jens R. Chapman ◽  
Jefferson R. Wilson ◽  
Justin S. Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Nonoperative Treatment ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy

Study Design: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease that is increasingly managed surgically. The objective of this study is to determine the role of nonoperative treatment in the management of DCM by updating a systematic review published by Rhee and colleagues in 2013. The specific aims of this review were (1) to determine the comparative efficacy, effectiveness, and safety of nonoperative and surgical treatment; (2) to assess whether myelopathy severity differentially affects outcomes of nonoperative treatment; and (3) to evaluate whether activities or minor injuries are associated with neurological deterioration. Methods: Methods from the original review were used to search for new literature published between July 20, 2012, and February 12, 2015. Results: The updated search yielded 2 additional citations that met inclusion criteria and compared the efficacy of conservative management and surgical treatment. Based on a single retrospective cohort, there were no significant differences in posttreatment Japanese Orthopaedic Association (JOA) or Neck Disability Index scores or JOA recovery ratios between patients treated nonoperatively versus operatively. A second retrospective study indicated that the incidence rate of hospitalization for spinal cord injury was 13.9 per 1000 person-years in a nonoperative group compared with 9.4 per 1000 person-years in a surgical group (adjusted hazard ratio = 1.57; 95% confidence interval = 1.11-2.22; P = .011). Conclusion: Nonoperative management results in similar outcomes as surgical treatment in patients with a modified JOA ≥ 13, single-level myelopathy and intramedullary signal change on T2-weighted magnetic resonance imaging. Furthermore, patients managed nonoperatively for DCM have higher rates of hospitalization for spinal cord injury than those treated surgically. The overall level of evidence for these findings was rated as low.

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