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Ao Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - a Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy Publisher



Fehlings MG1 ; Evaniew N2 ; Ter Wengel PV3 ; Vedantam A4 ; Guha D5 ; Margetis K6 ; Nouri A7 ; Ahmed AI8 ; Neal CJ9 ; Davies BM10 ; Ganau M11 ; Wilson JR12 ; Martin AR13 ; Grassner L14 Show All Authors
Authors
  1. Fehlings MG1
  2. Evaniew N2
  3. Ter Wengel PV3
  4. Vedantam A4
  5. Guha D5
  6. Margetis K6
  7. Nouri A7
  8. Ahmed AI8
  9. Neal CJ9
  10. Davies BM10
  11. Ganau M11
  12. Wilson JR12
  13. Martin AR13
  14. Grassner L14
  15. Tetreault L15
  16. Rahimimovaghar V16
  17. Marco R17
  18. Harrop J18
  19. Guest J19
  20. Alvi MA20
  21. Pedro KM20
  22. Kwon BK21
  23. Fisher CG22
  24. Kurpad SN4
Show Affiliations
Authors Affiliations
  1. 1. Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
  2. 2. Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
  3. 3. Department of Neurosurgery, Haaglanden Medical Center, Hague, Netherlands
  4. 4. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
  5. 5. Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
  6. 6. The Mount Sinai Hospital, New York, NY, United States
  7. 7. Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
  8. 8. Wolfson SPaRC, King’s College London, London, United Kingdom
  9. 9. Division of Neurosurgery, Maine Medical Center, Portland, ME, United States
  10. 10. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
  11. 11. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
  12. 12. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
  13. 13. University of California Davis, Davis, CA, United States
  14. 14. Department of Neurosurgery, Christian Doppler Clinic., Paracelsus Medical University, Salzburg, Austria
  15. 15. NYU Langone Health, NY, United States
  16. 16. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  17. 17. UT Health Houston McGovern Medical School, Houston, TX, United States
  18. 18. Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
  19. 19. University of Miami, Miami, FL, United States
  20. 20. Institute of Medical Science, University of Toronto, Toronto, Canada
  21. 21. The University of British Columbia, Vancouver, BC, Canada
  22. 22. Division of Spine Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada

Source: Global Spine Journal Published:2025


Abstract

Study Design: Literature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations. Objective: This article summarizes several key current topics related to the management of DCM. Methods: Recent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional. Results: Article 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. Conditional recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. Conditional recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. Strong recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. Conditional recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients. Conclusions: DCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles. © The Author(s) 2025.
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