Priority 9 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What is the role of dynamic imaging and novel, unconventional or advanced techniques in the assessment of DCM? (JLA PSP Priority 9)
Overall ranking	9
JLA question ID	0097/9
Explanatory note	Spinal cord and nerve root compression can be aggravated by dynamic mechanisms. Specifically, the spinal cord can be compressed by ventral osteophytes during neck flexion and pinched between the vertebral body and the lamina or ligamentum flavum during neck extension. Dynamic cord compression may be missed if only a static MRI is performed. Dynamic imaging may be more sensitive at detecting cervical cord compression than routine MRIs done in a neutral position. Other novel imaging techniques may be better able to quantify axonal integrity, demyelination, neuronal atrophy and other aspects of spinal cord microstructure and tissue injury. This information may be beneficial in detecting early disease progression, selecting surgical candidates and accurately predicting treatment outcomes.
Evidence	No guidelines identified. Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin. 2015 Dec 4;10:192-238. Ellingson BM, Salamon N, Holly LT. Advances in MR imaging for cervical spondylotic myelopathy. Eur Spine J. 2015 Apr;24 Suppl 2:197-208.
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Why isn't Dynamic MRI with the neck positioned in flexion and then extension more common when research shows that intermittent and dynamic compression causes progression of DCM? ~ Is dynamic cervical MRI a mandatory tool in diagnosing cervical myelopathy? ~ Are dynamic MRI scans valuable? ~ Is MRI tractography useful in diagnosis of CSM? ~ What is the role of DTI in imaging DCM?
Submitted by	Spinal Surgeons x 39, Other healthcare professionals x 6, People with DCM and their supporters x 2

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