Priority 9 from the Degenerative Cervical Myelopathy PSP
|UNCERTAINTY: What is the role of dynamic imaging and novel, unconventional or advanced techniques in the assessment of DCM? (JLA PSP Priority 9)
|JLA question ID
|Spinal cord and nerve root compression can be aggravated by dynamic mechanisms. Specifically, the spinal cord can be compressed by ventral osteophytes during neck flexion and pinched between the vertebral body and the lamina or ligamentum flavum during neck extension. Dynamic cord compression may be missed if only a static MRI is performed. Dynamic imaging may be more sensitive at detecting cervical cord compression than routine MRIs done in a neutral position. Other novel imaging techniques may be better able to quantify axonal integrity, demyelination, neuronal atrophy and other aspects of spinal cord microstructure and tissue injury. This information may be beneficial in detecting early disease progression, selecting surgical candidates and accurately predicting treatment outcomes.
No guidelines identified.
|Health Research Classification System category
|Extra information provided by this PSP
|Original uncertainty examples
Why isn't Dynamic MRI with the neck positioned in flexion and then extension more common when research shows that intermittent and dynamic compression causes progression of DCM? ~ Is dynamic cervical MRI a mandatory tool in diagnosing cervical myelopathy? ~ Are dynamic MRI scans valuable? ~ Is MRI tractography useful in diagnosis of CSM? ~ What is the role of DTI in imaging DCM?
|Spinal Surgeons x 39, Other healthcare professionals x 6, People with DCM and their supporters x 2
|PSP unique ID
|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