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2018 ; 91
(1
): 43-48
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Degenerative Cervical Myelopathy: A Clinical Review
#MMPMID29599656
Gibson J
; Nouri A
; Krueger B
; Lakomkin N
; Nasser R
; Gimbel D
; Cheng J
Yale J Biol Med
2018[Mar]; 91
(1
): 43-48
PMID29599656
show ga
Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord
impairment in adults and results in disability and reduced quality of life. DCM
can present with a wide set of clinical and imaging findings, including: 1) pain
and reduced range of motion of the neck, and motor and sensory deficits on
clinical exam, and 2) cord compression due to static and dynamic injury
mechanisms resulting from degenerative changes of the bone, ligaments, and
intervertebral discs on MRI. The incidence and prevalence of DCM has been
estimated at a minimum of 4.1 and 60.5 per 100,000, respectively, but surgical
trends and an aging population suggest these numbers will rise in the future. The
diagnosis of DCM is based on clinical examination, with a positive Hoffmann's
sign and hand numbness typically appearing in the upper limbs, and gait
abnormalities such as difficulty with tandem gait serving as sensitive diagnostic
findings. Loss of bladder function may also occur in patients with severe DCM.
The degree of neurological impairment can be measured using the modified Japanese
Association Scale (mJOA) or Nurick grade. Non-operative management has a limited
role in the treatment, while surgical management has been shown to both be safe
and effective for halting disease progression and improving neurological
function. Predictors of surgical outcome include age and baseline severity,
indicating that early recognition of DCM is important for ensuring an optimal
surgical outcome.
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