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Degenerative cervical myelopathy - update and future directions.
Journal article

Degenerative cervical myelopathy - update and future directions.

  • Badhiwala JH Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Ahuja CS Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Akbar MA Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Witiw CD Division of Neurosurgery, Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
  • Nassiri F Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Furlan JC Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
  • Curt A Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland.
  • Wilson JR Division of Neurosurgery, Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
  • Fehlings MG Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. michael.fehlings@uhn.ca.
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  • 2020-01-25
Published in:
  • Nature reviews. Neurology. - 2020
Cervical Vertebrae
Humans
Magnetic Resonance Imaging
Spinal Cord Compression
Spinal Cord Diseases
English Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/236901
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