Priority 13 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What are the most effective therapies for treatment of specific symptoms of DCM and the prevention of associated complications in DCM, including spasticity, imbalance and sensory, bladder or bowel dysfunction?   (JLA PSP Priority 13)
Overall ranking 13
JLA question ID 0097/13
Explanatory note Several ascending and descending spinal tracts can be affected by degenerative changes in the cervical spinal cord. DCM results in sensory and motor impairment in the upper and lower extremities, bladder and bowel dysfunction and a combined upper and lower motor neuron picture. As a result, patients may have debilitating hand weakness, lower limb spasticity, gait disturbances, incontinence and proprioception deficits. Treatment protocols must be established to manage and prevent some of the associated complications of DCM that can be present both before and after surgery. 

No systematic reviews, scoping reviews or guidelines identified

Health Research Classification System category Neurological
Extra information provided by this PSP
Original uncertainty examples

What are the therapeutic solutions regarding urinary function? ~ Which therapy interventions are more helpful with gait balance? ~ What are best treatments for residual symptoms after a successful decompression? Specifically I have a few patients with uncontrollable muscle spasms following decompression. ~ How can we improve care of spasticity? ~ Does Botox have a role in improving spasticity after decompressive surgery?

Submitted by Spinal Surgeons x 22, Other healthcare professionals x 7, People with DCM and their supporters x 13
PSP information
PSP unique ID 0097
PSP name Degenerative Cervical Myelopathy
Total number of uncertainties identified by this PSP. 76  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 20 November 2019