The following is a summary of “Natural History of Degenerative Cervical Myelopathy” published in the December 2022 issue of Surgery by Houten et al.
The most common cause of spinal cord dysfunction and injury in adults, degenerative cervical myelopathy (DCM), has a devastating effect on the quality of life, productivity, and economy due to the high cost of treatment and the time off work it necessitates. Patients with worsening neurological signs and symptoms of myelopathy are candidates for surgical surgery, although there is some debate over the best way to treat those with less severe symptoms.
Therefore, it is crucial to screen patients and identify those most adequately suited for surgical care by learning about the natural history of DCM. Most published research on the natural history of these patients has methodological problems or underpowered to provide definitive answers, despite attempts to do such studies rigorously. Clinical guidance for selecting surgical candidates can be gleaned from studies of subsets of patients, such as those with lower baseline mJOA scores, evidence of segmental hypermobility, cord signal changes on Magnetic resonance imaging(MRI), abnormal somatosensory or motor evoked potentials or the presence of certain inflammatory markers.
When deciding on a course of treatment for a patient with mild myelopathy or asymptomatic cervical spinal cord compression, clinicians should conduct a patient-specific assessment, and knowledge of the factors that may affect natural history may help determine which patients would benefit most from surgical intervention. In addition, future research will likely reveal how natural history factors might be exploited to develop more specific treatment algorithms.