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 Publisher



Fehlings MG¹ ; Evaniew N² ; Ter Wengel PV³ ; Vedantam A⁴ ; Guha D⁵ ; Margetis K⁶ ; Nouri A⁷ ; Ahmed AI⁸ ; Neal CJ⁹ ; Davies BM¹⁰ ; Ganau M¹¹ ; Wilson JR¹² ; Martin AR¹³ ; Grassner L¹⁴ Show All Authors
Source: Global Spine Journal Published:2025

Abstract

Study Design: Literature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations. Objective: This article summarizes several key current topics related to the management of DCM. Methods: Recent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional. Results: Article 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. Conclusions: DCM 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. © The Author(s) 2025.