%0 Journal Article
%T Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2].
%A Nouri A
%A Tessitore E
%A Molliqaj G
%A Meling T
%A Schaller K
%A Nakashima H
%A Yukawa Y
%A Bednarik J
%A Martin AR
%A Vajkoczy P
%A Cheng JS
%A Kwon BK
%A Kurpad SN
%A Fehlings MG
%A Harrop JS
%A Aarabi B
%A Rahimi-Movaghar V
%A Guest JD
%A Davies BM
%A Kotter MRN
%A Wilson JR
%J Global Spine J
%V 12
%N 1
%D Feb 2022
%M 35174726
%F 2.23
%R 10.1177/21925682211036071
%X METHODS: Narrative review.
OBJECTIVE: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).
METHODS: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.
RESULTS: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years.
CONCLUSIONS: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.