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

Jamie F. Brannigan, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Benjamin M. Davies, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. info@myelopathy.org.
Oliver D. Mowforth, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Ratko Yurac, Spine unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile.
Vishal Kumar, Department of Orthopaedics, PGIMER, Chandigarh, India.
Joost Dejaegher, Department of Neurosurgery, University Hospitals Leuven, Leuven, KU Leuven, Belgium.
Juan J. Zamorano, Spine unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile.
Rory K. Murphy, Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Manjul Tripathi, Department of Orthopaedics, PGIMER, Chandigarh, India.
David B. Anderson, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
James Harrop, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Granit Molliqaj, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
Guy Wynne-Jones, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
Jose Joefrey Arbatin, Orthopedic surgeon, Spine and Orthopedics, Chong Hua Hospital, Cebu, Philippines.
So Kato, The University of Tokyo Hospital, Tokyo, Japan.
Manabu Ito, Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
Jefferson Wilson, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Ronie Romelean, Jayapalan Division of Neurosurgery, Department of Surgery, University Malaya Medical Centre, Petaling Jaya, Kuala Lumpur, Malaysia.
Nicolas Dea, Combined Neurosurgical and Orthopedic Spine Program. Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
Daniel Graves, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Enrico Tessitore, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
Allan R. Martin, University of California, Davis, California, USA.
Aria Nouri, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.

Document Type

Article

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.

Publication Date

12-21-2023

Publication Title

Spinal cord

E-ISSN

1476-5624

PubMed ID

38129661

Digital Object Identifier (DOI)

10.1038/s41393-023-00945-8

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