Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management

Abstract

The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.

Keywords: Biomarkers; Degenerative cervical myelopathy; Magnetic resonance imaging; Surgery.

Fig. 1.

T2 sagittal magnetic resonance imaging of 2 patients pre- and postoperative surgical decompression for degenerative cervical myelopathy, with the additional of the modified K-line in red. Panel A demonstrates an example of loss of the normal cervical lordosis, with the anterior compressive elements <4 mm from the modified K-line that was successfully treated with a multilevel anterior approach (B). Panel C demonstrates an example where the modified K-line does not abut the anterior elements, that was amenable to the posterior cervical approach (D).