Degenerative Cervical Myelopathy: Clinical Evaluation Methods and Treatment Selection Algorithm
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in developed countries, and its prevalence is only growing due to population ageing. It can be caused by various degenerative changes in the cervical spine that affect one or more anatomical structures, including vertebrae, intervertebral discs and ligaments of the spine. Neurological deficit resulting from chronic spinal cord compression in DCM can lead to significant disability. Irreversible disability can be prevented by early diagnosis and intervention at the initial stages of the disease. Over the past decade, advances in basic science enabled a more thorough study of DCM pathophysiology and use of new diagnostic tools for clinical practice. Latest neuroimaging techniques and neurophysiological studies open up prospects for quantitative assessment of spinal cord tissue damage and prediction of treatment outcome. Surgical decompression is currently recommended for moderate to severe cases, but the best treatment strategy for mild myelopathy is still undefined. This review provides current data on the definition, clinical manifestation, diagnosis and treatment of DCM. Particular attention is given to diagnostic methods (both prospective and currently used in clinical practice) that can not only identify early stages of the disease, but also allow to predict the outcome of surgical intervention. Diagnostic algorithm for treatment selection is established, which opens up new possibilities for a more personalized approach in the treatment of DCM.