AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy. Global Spine J 2025 Jun;15(5):2585-2593
Date
04/21/2025Pubmed ID
40257837Pubmed Central ID
PMC12012498DOI
10.1177/21925682251331050Scopus ID
2-s2.0-105004277039 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
Study DesignLiterature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations.ObjectiveThis article summarizes several key current topics related to the management of DCM.MethodsRecent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional.ResultsArticle 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. Conditional recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. Conditional recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. Strong recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. Conditional recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients.ConclusionsDCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles.
Author List
Fehlings MG, Evaniew N, Ter Wengel PV, Vedantam A, Guha D, Margetis K, Nouri A, Ahmed AI, Neal CJ, Davies BM, Ganau M, Wilson JR, Martin AR, Grassner L, Tetreault L, Rahimi-Movaghar V, Marco R, Harrop J, Guest J, Alvi MA, Pedro KM, Kwon BK, Fisher CG, Kurpad SN, AO Spine Knowledge Forum Spinal Cord InjuryAuthors
Shekar N. Kurpad PhD, MD President in the President department at Medical College of WisconsinAditya Vedantam MBBS Associate Professor in the Neurosurgery department at Medical College of Wisconsin
