Review

. 2025 Jun;15(5):2585-2593.

doi: 10.1177/21925682251331050. Epub 2025 Apr 21.

AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy

Michael G Fehlings¹, Nathan Evaniew², Paula Valerie Ter Wengel³, Aditya Vedantam⁴, Daipayan Guha⁵, Konstantinos Margetis⁶, Aria Nouri⁷, Aminul I Ahmed⁸, Chris J Neal⁹, Benjamin M Davies¹⁰, Mario Ganau¹¹, Jefferson R Wilson¹², Allan R Martin¹³, Lukas Grassner¹⁴, Lindsay Tetreault¹⁵, Vafa Rahimi-Movaghar¹⁶, Rex Marco¹⁷, James Harrop¹⁸, James Guest¹⁹, Mohammed Ali Alvi²⁰, Karlo M Pedro²⁰, Brian K Kwon²¹, Charles G Fisher²², Shekar N Kurpad⁴; AO Spine Knowledge Forum Spinal Cord Injury

Affiliations

¹ Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada.
² Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
³ Department of Neurosurgery, Haaglanden Medical Center, Hague, the Netherlands.
⁴ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
⁵ Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
⁶ The Mount Sinai Hospital, New York, NY, USA.
⁷ Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
⁸ Wolfson SPaRC, King's College London, London, UK.
⁹ Division of Neurosurgery, Maine Medical Center, Portland, ME, USA.
¹⁰ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
¹¹ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹² Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹³ University of California Davis, Davis, CA, USA.
¹⁴ Department of Neurosurgery, Christian Doppler Clinic. Paracelsus Medical University, Salzburg, Austria.
¹⁵ NYU Langone Health, New York, USA.
¹⁶ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
¹⁷ UT Health Houston McGovern Medical School, Houston, TX, USA.
¹⁸ Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁹ University of Miami, Miami, FL, USA.
²⁰ Institute of Medical Science, University of Toronto, Toronto, Canada.
²¹ The University of British Columbia, Vancouver, BC, Canada.
²² Division of Spine Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.

PMID: 40257837
PMCID: PMC12012498
DOI: 10.1177/21925682251331050

Review

AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy

Michael G Fehlings et al. Global Spine J. 2025 Jun.

. 2025 Jun;15(5):2585-2593.

doi: 10.1177/21925682251331050. Epub 2025 Apr 21.

Authors

Affiliations

¹ Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada.
² Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
³ Department of Neurosurgery, Haaglanden Medical Center, Hague, the Netherlands.
⁴ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
⁵ Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
⁶ The Mount Sinai Hospital, New York, NY, USA.
⁷ Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
⁸ Wolfson SPaRC, King's College London, London, UK.
⁹ Division of Neurosurgery, Maine Medical Center, Portland, ME, USA.
¹⁰ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
¹¹ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹² Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹³ University of California Davis, Davis, CA, USA.
¹⁴ Department of Neurosurgery, Christian Doppler Clinic. Paracelsus Medical University, Salzburg, Austria.
¹⁵ NYU Langone Health, New York, USA.
¹⁶ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
¹⁷ UT Health Houston McGovern Medical School, Houston, TX, USA.
¹⁸ Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁹ University of Miami, Miami, FL, USA.
²⁰ Institute of Medical Science, University of Toronto, Toronto, Canada.
²¹ The University of British Columbia, Vancouver, BC, Canada.
²² Division of Spine Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.

PMID: 40257837
PMCID: PMC12012498
DOI: 10.1177/21925682251331050

Abstract

Study DesignLiterature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations.ObjectiveThis article summarizes several key current topics related to the management of DCM.MethodsRecent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional.ResultsArticle 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. Conditional recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. Conditional recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. Strong recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. Conditional recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients.ConclusionsDCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles.

Keywords: clinical recommendations; degenerative cervical myelopathy (DCM); management.

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Conflict of interest statement

Declaration of Conflicting InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MG Fehlings is a past chair and current advisory board member of the AO Spine Knowledge Forum Spinal Cord Injury.

Cited by

Rehabilitation for degenerative cervical myelopathy: systematic review and scoping review of UK patient information.
Smith TO, Newton C, Farrell A, Boby J, Dove J, Dove F, Turner K, Davies BM. Smith TO, et al. Spinal Cord. 2025 Jul 23. doi: 10.1038/s41393-025-01110-z. Online ahead of print. Spinal Cord. 2025. PMID: 40696144 Review.

References

1. Davies BM, Khan DZ, Barzangi K, et al. We choose to call it ‘degenerative cervical myelopathy’: findings of AO spine RECODE-DCM, an international and multi-stakeholder partnership to agree a standard unifying term and definition for a disease. Global Spine J. 2024;14(2):503-512. - PMC - PubMed
1. Badhiwala JH, Ahuja CS, Akbar MA, et al. Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol. 2020;16:108-124. - PubMed
1. Fehlings MG, Tetreault LA, Riew KD, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7:70S-83S. - PMC - PubMed
1. Davies BM, Khan DZ, Mowforth OD, et al. RE-CODE DCM (REsearch objectives and common data elements for degenerative cervical myelopathy): a consensus process to improve research efficiency in DCM, through establishment of a standardized dataset for clinical research and the definition of the research priorities. Global Spine J. 2019;9:65S-76S. - PMC - PubMed
1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924-926. - PMC - PubMed

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AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy

Affiliations

AO Spine Clinical Practice Recommendations for Diagnosis and Management of Degenerative Cervical Myelopathy: Evidence Based Decision Making - A Review of Cutting Edge Recent Literature Related to Degenerative Cervical Myelopathy

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Conflict of interest statement

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