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Review
. 2025 Sep;15(7):3506-3516.
doi: 10.1177/21925682251339480. Epub 2025 Apr 30.

A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence Synthesis to Inform an AO Spine Expert Opinion Statement

Vinisha Agrawal  1 , Mohammed Farhan Ali  1 , Froher Yasin  1 , Daniyal Ashraf  1 , Jamie F M Brannigan  1 , Ratko Yurac  2 , Vishal Kumar  3 , Rory Murphy  4 , Enrico Tessitore  5 , Granit Molliqaj  5 , Joost Dejaegher  6 , Juan José Zamorano  2   7 , Guy Wynne-Jones  8 , Manjul Tripathi  9 , David B Anderson  10 , Jose Joefrey F Arbatin  11 , So Kato  12 , Ronie Romelean Jayapalan  13 , Nicolas Dea  14 , James S Harrop  15 , Jefferson Wilson  16 , Brian K Kwon  17 , Allan R Martin  18 , Josef Bednarik  19 , Mark R Kotter  20 , Benjamin M Davies  20 , Oliver D Mowforth  20 , Aria Nouri  5   20
Affiliations
Review

A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence Synthesis to Inform an AO Spine Expert Opinion Statement

Vinisha Agrawal et al. Global Spine J. 2025 Sep.

Abstract

Study DesignSystematic review.ObjectivesThe pre-symptomatic state of Degenerative Cervical Myelopathy (DCM), wherein degenerative changes and spinal cord compression are seen without clinical findings, is poorly understood and inconsistently categorised. Clear identification may elucidate the temporality of DCM development. Therefore, a systematic assessment was undertaken of current terminology for pre-DCM states, with the objective of standardising definitions and informing an AO Spine expert position statement.MethodsMedline and Embase were searched for all studies on asymptomatic spinal compression or clinical findings preceding DCM, returning 3585 studies. After screening, 96 studies were included in the final analysis. The terminology used for pre-DCM states and their definitions were extracted, along with their frequencies or speciality/country of author in the literature.ResultsMultiple terms were used to represent pre-DCM stages, including "asymptomatic" (86 studies), "non-myelopathic" (26 studies), "without myelopathy" (15 studies), "pre-symptomatic" (9 studies) and "sub-clinical" (7 studies). "asymptomatic" was associated with the greatest inconsistency. Some defined this as patients with radiological signs of spinal degeneration with/without spinal cord compression but no clinical signs of myelopathy, whereas others used the term synonymously with healthy controls. This inconsistency is particularly challenging in clinical studies in which DCM patients are compared to those with pre-DCM states and/or healthy volunteers.ConclusionThere is substantial inconsistency in the terms used to describe pre-DCM states. There is no clear relationship between the terms used and the country or speciality of the main author. Standardised definitions for these disease states should be agreed and used in future studies.

Keywords: cervical myelopathy; cervical stenosis; disc herniation; ossification of the posterior longitudinal ligament; spinal cord compression; spinal stenosis; spondylosis.

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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.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection.
Figure 2.
Figure 2.
The frequency of different terms used to describe pre-DCM states from 2012-2024.
Figure 3.
Figure 3.
The absolute frequency of different terms used to describe pre-DCM states in different countries.
Figure 4.
Figure 4.
The relative frequency of different terms used to describe pre-DCM states by different specialities. Total numbers of papers from each specialty included in brackets after specialty name.
Figure 5.
Figure 5.
Frequency table of the quality and bias assessment scores for the studies included in data extraction.
See this image and copyright information in PMC

References

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