Priority 2 from the Degenerative Cervical Myelopathy PSP
|UNCERTAINTY: What is the natural history of DCM? What is the relationship between DCM and asymptomatic spinal cord compression or canal stenosis? What factors influence the natural history of the disease? (JLA PSP Priority 2)|
|JLA question ID||0097/2|
|Explanatory note||The pattern of progression in DCM is highly variable and not well defined. In a systematic review by Karadimas et al (2013), moderate evidence suggested that 20% to 62% of patients deteriorate by at least 1 point on the Japanese Orthopedic Association scale at 3 to 6 years after initial assessment. This conclusion was largely based on longitudinal nonsurgical cohorts and studies comparing operative versus nonoperative management. This systematic review also evaluated risk factors associated with disease progression. There was low to insufficient evidence on this topic, preventing the development of meaningful recommendations. In a systematic review by Wilson et al (2013), low evidence suggested that, in non-myelopathic patients with cervical canal stenosis and cord compression, approximately 8% at 1-year and 23% at a 44-months will develop clinical evidence of myelopathy. Important predictors of the onset of DCM included presence of symptomatic radiculopathy, prolonged SEPs and MEPs and EMG signs of anterior horn cell lesion (low to moderate evidence). There was no consensus with respect to the presence of T2 signal changes on magnetic resonance imaging. Further studies are required to better define the natural history of DCM and relevant predictors of disease development and progression.|
Systematic reviews on the topic rated the level of evidence as low to moderate.
|Health Research Classification System category||
|Extra information provided by this PSP|
|Original uncertainty examples||
What is the natural history of DCM without surgical intervention? ~ Is it reversible? ~ What proportion with asymptomatic cervical cord compression develops DCM? Why do some asymptomatic cervical cord compressions never develop DCM? ~ What are the outcomes of unsymptomatic stenosis? ~ How long is the neurological plateau after an exacerbation of DCM? ~ What is the rate of deterioration with patients with DCM?
|Submitted by||Spinal Surgeons x 44, Other healthcare professionals x 15, People with DCM and their supporters x 11|
|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|