Abstract
ObjectivesThe mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM.Study designRetrospective cohort study.Methods1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations.ResultsOf the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant.ConclusionsCord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.
Highlights
The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance
Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines
Degenerative Cervical Myelopathy (DCM) is a progressive condition characterized by degenerative changes in the cervical spine leading to chronic spinal cord compression
Summary
Degenerative Cervical Myelopathy (DCM) is a progressive condition characterized by degenerative changes in the cervical spine leading to chronic spinal cord compression. Pathological changes include osteophytosis, intervertebral disc bulging, and ligament ossification and hypertrophy leading to static and dynamic injury to the spinal cord [1]. DCM is the commonest cause of spinal cord dysfunction with an estimated minimum incidence and prevalence of 41 and 605 per 1,000,000 respectively in North America. The actual prevalence is likely to be much higher given under and misdiagnosis is common [2]. Estimates based on imaging series could put the prevalence as high as 5% in over 40 year olds [3,4]. DCM looks to become an increasing healthcare burden
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