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.

Authors

Michael G Fehlings
Nathan Evaniew
Paula Valerie Ter Wengel
Aditya Vedantam
Daipayan Guha
Konstantinos Margetis
Aria Nouri
Aminul I Ahmed
Chris J Neal
Benjamin M Davies
Mario Ganau
Jefferson R Wilson
Allan R Martin
Lukas Grassner
Lindsay Tetreault
Vafa Rahimi-Movaghar
Rex Marco
James Harrop
James Guest
Mohammed Ali Alvi
Karlo M Pedro
Brian K Kwon
Charles G Fisher
Shekar N Kurpad

Publication Date

6-1-2025

Journal

Global Spine Journal

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.

Keywords

degenerative cervical myelopathy (DCM), management, clinical recommendations

DOI

10.1177/21925682251331050

PMID

40257837

PMCID

PMC12012498

PubMedCentral® Posted Date

4-21-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes