Priority 14 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What are the factors that predict the development of myelopathy in patients with evidence of spinal cord compression and no symptoms? (JLA PSP Priority 14)
Overall ranking 14
JLA question ID 0097/14
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 change impacts the development of myelopathy. Further studies are required to better identify relevant clinical and imaging predictors of disease development in nonmyelopathic patients with evidence of cervical canal stenosis and cord compression. 

A systematic review on the topic rated the level of evidence as insufficient to moderate.
Wilson JR, Barry S, Fischer DJ, Skelly AC, Arnold PM, Riew KD, Shaffrey CI, Traynelis VC, Fehlings MG. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S37-54.

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

Which is the single most important finding to consider in MRI when counselling asymptomatic patients with spinal cord compression? ~ Are there any clinical or radiological biomarkers that may predict which patients with cervical spondylosis may progress to DCM? ~ Is the presence of hyperintensity signal in the spinal cord of an asymptomatic patient predictive of future developing of DCM? ~ In a patient is cervical stenosis and no symptoms or signs of DCM, are there subtle features that can predict a future deterioration or onset of DCM?

Submitted by Spinal Surgeons x 14, Other healthcare professionals x  3, People with DCM and their supporters x  1
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