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. 2024 Jun;14(5):1664-1677.
doi: 10.1177/21925682231224768. Epub 2023 Dec 26.

Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis

Tanzil Rujeedawa  1 , Oliver D Mowforth  1 , Benjamin M Davies  1 , Cylene Yang  1 , Aria Nouri  1   2 , Jibin J Francis  1 , Bizhan Aarabi  3 , Brian K Kwon  4 , James Harrop  5 , Jefferson R Wilson  6 , Allan R Martin  7 , Vafa Rahimi-Movaghar  8 , James D Guest  9 , Michael G Fehlings  10 , Mark R Kotter  1
Affiliations

Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis

Tanzil Rujeedawa et al. Global Spine J. 2024 Jun.

Abstract

Study design: Literature Review.

Objective: Myelopathy affecting the thoracic spinal cord can arise secondary to several aetiologies which have similar presentation and management. Consequently, there are many uncertainties in this area, including optimal terminology and definitions. Recent collaborative cervical spinal research has led to the proposal and subsequent community adoption of the name degenerative cervical myelopathy(DCM), which has facilitated the establishment of internationally-agreed research priorities for DCM. We put forward the case for the introduction of the term degenerative thoracic myelopathy(DTM) and degenerative spinal myelopathy(DSM) as an umbrella term for both DCM and DTM.

Methods: Following PRISMA guidelines, a systematic literature search was performed to identify degenerative thoracic myelopathy literature in Embase and MEDLINE.

Results: Conditions encompassed within DTM include thoracic spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, calcification of ligaments, hypertrophy of ligaments, degenerative disc disease, thoracic osteoarthritis, intervertebral disc herniation, and posterior osteophytosis. The classic presentation includes girdle pain, gait disturbance, leg weakness, sensory disturbance, and bladder or bowel dysfunction, often with associated back pain. Surgical management is typically favoured with post-surgical outcomes dependent on many factors, including the causative pathology, and presence of additional stenosis.

Conclusion: The clinical entities encompassed by the term DTM are interrelated, can manifest concurrently, and present similarly. Building on the consensus adoption of DCM in the cervical spine and the recent proposal of degenerative cervical radiculopathy(DCR), extending this common nomenclature framework to the terms degenerative spinal myelopathy and degenerative thoracic myelopathy will help improve recognition and communication.

Keywords: disc herniation; myelopathy; ossification of the posterior longitudinal ligament; spondylosis; stenosis; thoracic.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A sagittal view of the thoracic spine demonstrates several pathologies that can cause DTM, including spondylosis, degenerative disc disease, and ossification of the posterior longitudinal ligament.
Figure 2.
Figure 2.
Search methodology flowchart based on PRISMA 2020 statement..
Figure 3.
Figure 3.
A conceptual differentiation of the constituents of degenerative thoracic myelopathy. DTM can be due to either osteoarthritic or non-osteoarthritic degeneration. In addition, certain congenital abnormalities can predispose individuals to DTM. Figure drawn with reference to Nouri et al 2015.
See this image and copyright information in PMC

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