Degenerative Cervical Myelopathy Top 10
- What strategies can be used to increase awareness and understanding of DCM amongst healthcare professionals and the general public? Can these strategies help improve timely diagnosis and management of DCM?
- 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?
- What is the diagnostic criteria of DCM? When should imaging be used in the assessment of DCM?
- How can the severity of DCM be evaluated? What assessment tools can be used to evaluate functional impairment, disability and quality of life in patients with DCM? What instruments, tools or methods can be used or developed to monitor DCM patients for disease progression or improvement either before or after surgical treatment? Is there a role for smart-technology?
- What is the pathophysiology of DCM? What are the mechanisms of neurologic injury and the molecular and anatomical consequences?
- What is the role of rehabilitation following surgery for DCM? Can a structured postoperative rehabilitation improve outcome following surgery for DCM? What are the most effective strategies?
- Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?
- What is the socio-economic impact of DCM? (The financial impact of living with DCM to the sufferer, their supporters and society as a whole)
- What is the role of dynamic imaging and novel, unconventional or advanced techniques in the assessment of DCM?
- Are there clinical and imaging factors that can help a surgeon select who should undergo surgical decompression in the setting of DCM? At what stage of the disease is surgery the preferred management strategy?
The following questions were also discussed and put in order of priority at the workshop:
- What are the main signs and symptoms that a patient with DCM presents with? What are the frequency, sensitivity, specificity and positive predictive value of symptoms and signs (clinical assessments) for DCM?
- What is the optimal follow-up for patients managed conservatively and surgically? What is the appropriate follow-up for patients with DCM or those with spinal cord compression but no myelopathy symptoms? Who should be responsible for following these patients? How often should new imaging be obtained? How should changes in neurologic status be documented or addressed?
- 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?
- What are the factors that predict the development of myelopathy in patients with evidence of spinal cord compression and no symptoms?
- What are the most important determinants of functional outcomes, quality of life and patient satisfaction following surgical or non-operative treatment for DCM?
- What clinical and/or imaging features are predictive of neurologic deterioration in patients with DCM? Are there certain features that indicate irreversibility of the disease?
- What are the risk factors for the development or progression of DCM, including but not limited to, lifestyle, diet, exercise, posture, occupation, history of trauma and co-existent disease? Does their modification have a role in prevention or treatment?
- What is the ideal timing for surgical intervention?
- What is the efficacy and safety of non-operative treatment in the management of DCM compared with surgical treatment? Can non-operative treatment avoid the need for surgery long-term? When can a “watch and wait” approach be adopted?
- What are the most effective therapies for treating pain in patients with DCM?
- What is the preferred management strategy for patients with mild DCM? What is the most cost-effective management strategy in this cohort of patients? Are there clinical and imaging features that predict who should undergo surgical decompression and/or when?
- Can CSF or serum biomarkers be identified to support early diagnosis of DCM, and/or predict treatment outcomes?
- What lifestyle modifications (such as physical activity or exercise) are required or should be recommended to patients with DCM to support recovery, avoid deterioration and improve quality of life?
- 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?
- What treatments should be implemented following surgery and continued in the long-term? Is there a role for extended rehabilitation and exercise programs? What should be its frequency, content and duration, and whom should it be coordinated by?
- What is the incidence of adjacent segment degeneration following surgery for the treatment of DCM? Are there strategies that can be implemented to reduce the incidence of adjacent segment degeneration?
For full details of all of the questions identified by this PSP, please see the document below.