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 Show Affiliations
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.