Priority 7 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY:Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression? (JLA PSP Priority 7)
Overall ranking	7
JLA question ID	0097/7
Explanatory note	In patients with DCM, surgery is effective at halting neurological deterioration and improving functional impairment, disability and quality of life. Despite meaningful improvements, however, some patients experience residual neurological deficits and suffer postoperative complications such as new radiculopathy or disease progression. Given these residual postoperative deficits, there is an opportunity to explore adjuvant treatments for the management of DCM, including pharmacological, neuroprotective, stem-cell or gene therapies. The CSM-Protect study, led by Dr. Michael Fehlings, aimed to assess whether riluzole can enhance functional outcomes and improve pain in patients undergoing surgery for DCM. The results of this study have yet to be published. No other studies were identified that evaluated the use of novel therapies in the management of DCM.
Evidence	No systematic reviews, scoping reviews or guidelines identified
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	What novel treatments are currently in the works for DCM? ~ Are these likely to replace the gold standard treatments? ~ What treatments from the spinal cord injury literature are effective in patients with DCM? ~ What medicines or supplements are best? ~ What is the future of DCM treatment. Preventive treatment feasible? ~ Is stem cell therapy ever going to be introduced to counteract the damage done by this type of degeneration? ~ Which spinal cord pathways are preserved, and what is their capacity to restore function? Can electrical stimulation of the spinal cord/brain be used to restore function? ~ How to improve the outcome after surgery? ~ What is the role of THC and CBD in the treatment of DCM?
Submitted by	Spinal Surgeons x 59, Other healthcare professionals x 15, People with DCM and their supporters x 29

Extra information provided by this PSP

Original uncertainty examples

What novel treatments are currently in the works for DCM? ~ Are these likely to replace the gold standard treatments? ~ What treatments from the spinal cord injury literature are effective in patients with DCM? ~ What medicines or supplements are best? ~ What is the future of DCM treatment. Preventive treatment feasible? ~ Is stem cell therapy ever going to be introduced to counteract the damage done by this type of degeneration? ~ Which spinal cord pathways are preserved, and what is their capacity to restore function? Can electrical stimulation of the spinal cord/brain be used to restore function? ~ How to improve the outcome after surgery? ~ What is the role of THC and CBD in the treatment of DCM?

Submitted by

Spinal Surgeons x 59, Other healthcare professionals x 15, People with DCM and their supporters x 29

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