Priority 24 from the Degenerative Cervical Myelopathy PSP
|UNCERTAINTY: What is the role of surgery in the management of non-myelopathic patients with imaging evidence of cord compression? Is this decision impacted by signal change on T2-weighted MRI images or the presence of neck pain? (JLA PSP Priority 24)|
|JLA question ID||0097/24|
|Explanatory note||In a systematic review by Wilson et al (2013), low level evidence suggested that, in non-myelopathic patients with cervical canal stenosis and cord compression, approximately 8% at 1-year and 23% at 44-months will develop clinical evidence of myelopathy. Important predictors of disease development 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 whether the presence of T2 signal changes impacts te development of myelopathy. A recent clinical practice guideline aimed to address the following questions: should operative management be used to treat non-myelopathic patients with evidence of cord compression (i) without signs or symptoms of radiculopathy or (ii) and clinically/electrophysiological diagnosed radiculopathy. Two recommendations were developed; however, both were based on low quality evidence and were considered weak. Further research is required in order to better address these questions.|
A systematic review on the topic rated the level of evidence as insufficient to moderate. Strength was weak for all recommendations developed in the clinical practice guideline.
|Health Research Classification System category||Neurological|
|Extra information provided by this PSP|
|Original uncertainty examples||
Is there any benefit of surgically treating patients with cord compression but no/mild signs/symptoms of myelopathy?
|Submitted by||Spinal Surgeons x 27, Other healthcare professionals x 7, People with DCM and their supporters x 1|
|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|