Priority 18 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What is the ideal timing for surgical intervention? (JLA PSP Priority 18)
Overall ranking 18
JLA question ID 0097/18
Explanatory note Several studies have concluded that a longer duration of symptoms and more severe functional impairment are associated with worse surgical outcomes in patients with DCM. Based on these results, it is important that DCM is diagnosed in a timely fashion and that patients are evaluated early to see if they are surgical candidates. Some patients may have milder signs and symptoms of myelopathy and may remain stable for many years. In these cases, surgery may pose a greater risk than benefit. It is important to distinguish between patients who are likely to remain mild for years and those who may rapidly progress to more moderate and severe forms of DCM. Many factors influence the ideal  timing for surgical intervention. A treatment algorithm would be helpful to guide referrals and management decisions. 

Development of cervical spondylotic myelopathy: results of a systematic review.

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

What is the ideal time (or indicators) for intervention?  ~ When is the correct time to intervene definitively with surgery?  ~ Is there a timeframe beyond which intervention is futile? ~ When should we consider decompression surgery? ~ At which point of time should DCM be treated?

Submitted by Spinal Surgeons x 69, Other healthcare professionals x 25, People with DCM and their supporters x 16
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