Priority 10 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: Are there clinical and imaging factors that can help a surgeon select who should undergo surgical decompression in the setting of DCM? At what stage of the disease is surgery the preferred management strategy? (JLA PSP Priority 10)
Overall ranking	10
JLA question ID	0097/10
Explanatory note	In a recent clinical practice guideline, surgery was recommended as the treatment of choice in patients with moderate to severe myelopathy. These recommendations were based on two systematic reviews that concluded the following: (i) surgery results in significant improvements in mJOA, Neck Disability Index and Nurick scores at short-, medium- and long-term follow-up; (ii) the cumulative incidence of complications is low for patients treated surgically; and (iii) response to nonoperative treatment is minimal. In patients with mild myelopathy, the guideline suggested offering either surgical intervention or a supervised trial of structured rehabilitation. No clinical or imaging factors were outlined to help a surgeon select which mild patients should undergo surgical decompression.
Evidence	No systematic reviews, scoping reviews or guidelines identified
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Who are eligible for surgical treatment for DCM? ~ What are the clear indications for surgical intervention? ~ What are the contraindications for surgery? ~ How degree of clinical severity is appropriate to consider surgical indication for DCM? ~ At what stage does it become clear that surgical intervention is the preferred/desired treatment? ~ Which symptoms and/or signs and/or imaging features should trigger surgical treatment? ~ Can we use neurophysiology (SSEP, CMAP) to prognosticate and help in treatment decision analysis?
Submitted by	Spinal Surgeons x 49, Other healthcare professionals x 13, People with DCM and their supporters x 4

Extra information provided by this PSP

Original uncertainty examples

Who are eligible for surgical treatment for DCM? ~ What are the clear indications for surgical intervention? ~ What are the contraindications for surgery? ~ How degree of clinical severity is appropriate to consider surgical indication for DCM? ~ At what stage does it become clear that surgical intervention is the preferred/desired treatment? ~ Which symptoms and/or signs and/or imaging features should trigger surgical treatment? ~ Can we use neurophysiology (SSEP, CMAP) to prognosticate and help in treatment decision analysis?

Submitted by

Spinal Surgeons x 49, Other healthcare professionals x 13, People with DCM and their supporters x 4

PSP information
PSP unique ID	0097
PSP name	Degenerative Cervical Myelopathy
Total number of uncertainties identified by this PSP.	76 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	20 November 2019