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Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey

Brannigan JFM 1 , Davies BM 2 , Mowforth OD 1 , Yurac R 3 , Kumar V 4 , Dejaegher J 5 Show all authors , Zamorano JJ 3 , Murphy RKJ 6 , Tripathi M 4 , Anderson DB 7 , Harrop J 8 , Molliqaj G 9 , Wynne-Jones G 10 , Arbatin JJF 11 , Kato S 12 , Ito M 13 , Wilson J 14 , Romelean R 15 , Dea N 16 , Graves D 8 , Tessitore E 9 , Martin AR 17 , Nouri A 9

Affiliations 

  • 1 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
  • 2 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. info@myelopathy.org
  • 3 Spine unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile
  • 4 Department of Orthopaedics, PGIMER, Chandigarh, India
  • 5 Department of Neurosurgery, University Hospitals Leuven, Leuven, KU Leuven, Belgium
  • 6 Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, Arizona, USA
  • 7 Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • 8 Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
  • 9 Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
  • 10 The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
  • 11 Orthopedic surgeon, Spine and Orthopedics, Chong Hua Hospital, Cebu, Philippines
  • 12 The University of Tokyo Hospital, Tokyo, Japan
  • 13 Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
  • 14 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
  • 15 Jayapalan Division of Neurosurgery, Department of Surgery, University Malaya Medical Centre, Petaling Jaya, Kuala Lumpur, Malaysia
  • 16 Combined Neurosurgical and Orthopedic Spine Program. Vancouver General Hospital, University of British Columbia, Vancouver, Canada
  • 17 University of California, Davis, California, USA
Spinal Cord, 2024 Feb;62(2):51-58.
PMID: 38129661 DOI: 10.1038/s41393-023-00945-8

Abstract

STUDY DESIGN: Cross-sectional survey.

OBJECTIVE: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice.

METHODS: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC.

RESULTS: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text.

CONCLUSIONS: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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