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A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 5]: Mechanical Stress, Vulnerability and Time Publisher



Davies BM1 ; Mowforth O1 ; Gharooni AA1 ; Tetreault L2 ; Nouri A3 ; Dhillon RS4 ; Bednarik J5 ; Martin AR6 ; Young A1 ; Takahashi H7 ; Boerger TF8 ; Newcombe VFJ9 ; Zipser CM10 ; Freund P10 Show All Authors
Authors
  1. Davies BM1
  2. Mowforth O1
  3. Gharooni AA1
  4. Tetreault L2
  5. Nouri A3
  6. Dhillon RS4
  7. Bednarik J5
  8. Martin AR6
  9. Young A1
  10. Takahashi H7
  11. Boerger TF8
  12. Newcombe VFJ9
  13. Zipser CM10
  14. Freund P10
  15. Koljonen PA11
  16. Rodriguespinto R12, 13
  17. Rahimimovaghar V14
  18. Wilson JR15
  19. Kurpad SN8
  20. Fehlings MG15
  21. Kwon BK16
  22. Harrop JS17
  23. Guest JD18
  24. Curt A10
  25. Kotter MRN1

Source: Global Spine Journal Published:2022


Abstract

Study Design: Literature Review (Narrative) Objective: To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. Methods: Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual’s susceptibility, including the proposal of a new framework. Results: Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual’s vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. Conclusion: Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease. © The Author(s) 2021.
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