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Degenerative Cervical Myelopathy: Development and Natural History [Ao Spine Recode-Dcm Research Priority Number 2] Publisher



Nouri A1 ; Tessitore E1 ; Molliqaj G1 ; Meling T1 ; Schaller K1 ; Nakashima H2 ; Yukawa Y3 ; Bednarik J4 ; Martin AR5 ; Vajkoczy P6 ; Cheng JS7 ; Kwon BK8 ; Kurpad SN9 ; Fehlings MG10 Show All Authors
Authors
  1. Nouri A1
  2. Tessitore E1
  3. Molliqaj G1
  4. Meling T1
  5. Schaller K1
  6. Nakashima H2
  7. Yukawa Y3
  8. Bednarik J4
  9. Martin AR5
  10. Vajkoczy P6
  11. Cheng JS7
  12. Kwon BK8
  13. Kurpad SN9
  14. Fehlings MG10
  15. Harrop JS11
  16. Aarabi B12
  17. Rahimimovaghar V13
  18. Guest JD14
  19. Davies BM15, 16
  20. Kotter MRN15, 16
  21. Wilson JR10
Show Affiliations
Authors Affiliations
  1. 1. Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
  2. 2. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  3. 3. Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
  4. 4. Department of Neurology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
  5. 5. Department of Neurosurgery, University of California Davis, Sacramento, CA, United States
  6. 6. Department of Neurosurgery, Charite Universitatsmedizin, Berlin, Germany
  7. 7. Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, United States
  8. 8. Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
  9. 9. Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, United States
  10. 10. Division of Neurosurgery and Spine Program, University of Toronto, ON, Canada
  11. 11. Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
  12. 12. Department of Neurosurgery, University of Maryland, Baltimore, MD, United States
  13. 13. Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  14. 14. Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, FL, United States
  15. 15. Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom
  16. 16. Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom

Source: Global Spine Journal Published:2022


Abstract

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. © The Author(s) 2022.
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