Priority 5 from the Degenerative Cervical Myelopathy PSP
|UNCERTAINTY: What is the pathophysiology of DCM? What are the mechanisms of neurologic injury and the molecular and anatomical consequences? (JLA PSP Priority 5)|
|JLA question ID||0097/5|
|Explanatory note||DCM is a progressive disease caused by age-related degeneration of the facet joints, intervertebral disks, or vertebral bodies; hypertrophy of the ligamentum flavum; ossification of the posterior longitudinal ligament; and/or progressive cervical kyphosis. These changes ultimately narrow the spinal canal and reduce the space available for the spinal cord. Mechanical compression of the cord can result in a cascade of pathophysiological events, including ischemia, endothelial cell impairment, disruption of the blood-spinal cord barrier, neuroinflammation and apoptosis. Longstanding compression of the cord can lead to axonal demyelination, gliosis, scarring, degeneration of the corticospinal tracts, interneuronal loss and atrophy of the anterior horn cells. Despite this knowledge, further work is required to fully elucidate the pathophysiology of DCM and determine important therapeutic targets that might enhance recovery.|
No systematic reviews, scoping reviews or guidelines identified.
|Health Research Classification System category||Neurological|
|Extra information provided by this PSP|
|Original uncertainty examples||
What is the aetiology? ~ Why does DCM cause neurological impairment? What are the exact structures and neural pathways that are affected? ~ What spinal cord pathological changes underlie motor and sensory deficits in CSM? ~ What causes DCM?
|Submitted by||Spinal Surgeons x 12, Other healthcare professionals x 6, People with DCM and their supporters x 3|
|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|