Priority 16 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What clinical and/or imaging features are predictive of neurologic deterioration in patients with DCM? Are there certain features that indicate irreversibility of the disease? (JLA PSP Priority 16)
Overall ranking	16
JLA question ID	0097/16
Explanatory note	A systematic review by Karadimas et al (2013) aimed to evaluate important predictors of neurologic deterioration in patients with DCM. There was insufficient evidence to conclude whether disease progression is influenced by age at diagnosis, sex, developmental and dynamic cervical canal factors, T2 hyperintensity, and neck and head range of motion. There was low level evidence suggesting that circumferential spinal cord compression (compared with only partial cord compression) is associated with neurologic deterioration. Finally, there was insufficient evidence to evaluate the association between conversion to surgery and age, cervical range of motion, segmental lordotic angle, local slip, C2-7 alignment, spinal cord diameter, presence of developmental canal stenosis and segmental range of motion. An update of this systematic review in 2017 did not change these conclusions. Further studies are required to identify reliable clinical and imaging predictors of neurologic deterioration and determine which features indicate irreversibility of the disease.
Evidence	Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S21-36.
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	What factors influence DCM progression? ~ What factors can be used to predict progression in early DCM? ~ What lifestyle factors are associated with poorer DCM prognosis or disease progression? ~ Who is at risk of deteriorating? ~ Are there some biological markers which can predict evolution? What patient will evolve? and require surgery ~ Are there radiologic predictors to symptomatic progression?
Submitted by	Spinal Surgeons x 50, Other healthcare professionals x 23 People with DCM and their supporters x 4

Extra information provided by this PSP

Original uncertainty examples

What factors influence DCM progression? ~ What factors can be used to predict progression in early DCM? ~ What lifestyle factors are associated with poorer DCM prognosis or disease progression? ~ Who is at risk of deteriorating? ~ Are there some biological markers which can predict evolution? What patient will evolve? and require surgery ~ Are there radiologic predictors to symptomatic progression?

Submitted by

Spinal Surgeons x 50, Other healthcare professionals x 23
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