A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence Synthesis to Inform an AO Spine Expert Opinion Statement

Vinisha Agrawal, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Mohammed Farhan Ali, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Froher Yasin, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Daniyal Ashraf, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Jamie F. Brannigan, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Ratko Yurac, Division of Orthopaedic Surgery, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
Vishal Kumar, Division of Orthopaedic Surgery, PGIMER, Chandigarh, India.
Rory Murphy, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
Enrico Tessitore, Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Granit Molliqaj, Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Joost Dejaegher, Department of Neurosurgery, Faculty of Medicine KU Leuven, Leuven, Belgium.
Juan José Zamorano, Division of Orthopaedic Surgery, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
Guy Wynne-Jones, Department of Neurosurgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
Manjul Tripathi, Department of Neurosurgery, PGIMER, Chandigarh, India.
David B. Anderson, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Jose Joefrey F Arbatin, Spine and Orthopedics, Chong Hua Hospital, Cebu, Philippines.
So Kato, Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Ronie Romelean Jayapalan, Division of Neurosurgery, Department of Surgery, University Malaya Medical Centre, Petaling Jaya, Malaysia.
Nicolas Dea, Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
James S. Harrop, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Jefferson Wilson, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Brian K. Kwon, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Allan R. Martin, Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA.
Josef Bednarik, Department of Neurology, University Hospital Brno and Masaryk University, Brno, Czech Republic.
Mark R. Kotter, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Benjamin M. Davies, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Oliver D. Mowforth, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Aria Nouri, Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Document Type

Article

Abstract

Study DesignSystematic review.ObjectivesThe pre-symptomatic state of Degenerative Cervical Myelopathy (DCM), wherein degenerative changes and spinal cord compression are seen without clinical findings, is poorly understood and inconsistently categorised. Clear identification may elucidate the temporality of DCM development. Therefore, a systematic assessment was undertaken of current terminology for pre-DCM states, with the objective of standardising definitions and informing an AO Spine expert position statement.MethodsMedline and Embase were searched for all studies on asymptomatic spinal compression or clinical findings preceding DCM, returning 3585 studies. After screening, 96 studies were included in the final analysis. The terminology used for pre-DCM states and their definitions were extracted, along with their frequencies or speciality/country of author in the literature.ResultsMultiple terms were used to represent pre-DCM stages, including "asymptomatic" (86 studies), "non-myelopathic" (26 studies), "without myelopathy" (15 studies), "pre-symptomatic" (9 studies) and "sub-clinical" (7 studies). "asymptomatic" was associated with the greatest inconsistency. Some defined this as patients with radiological signs of spinal degeneration with/without spinal cord compression but no clinical signs of myelopathy, whereas others used the term synonymously with healthy controls. This inconsistency is particularly challenging in clinical studies in which DCM patients are compared to those with pre-DCM states and/or healthy volunteers.ConclusionThere is substantial inconsistency in the terms used to describe pre-DCM states. There is no clear relationship between the terms used and the country or speciality of the main author. Standardised definitions for these disease states should be agreed and used in future studies.

Publication Date

9-1-2025

Publication Title

Global spine journal

ISSN

2192-5682

Volume

15

Issue

7

First Page

3506

Last Page

3516

PubMed ID

40304598

Digital Object Identifier (DOI)

10.1177/21925682251339480

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