Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey
Jamie Brannigan, Benjamin M. Davies, Oliver Mowforth, Ratko Yurac, Vishal Kumar, Joost Dejaegher, Juan J. Zamorano, Rory K. J. Murphy, Manjul Tripathi, David Anderson, James S. Harrop, Granit Molliqaj, Guy Wynne-Jones, Jose Joefrey F. Arbatin, So Kato, Manabu Ito, Jefferson R. Wilson, Ronie Romelean, Nicolas Dea, Daniel Graves, Enrico Tessitore, Allan R. Martin, Aria Nouri
Abstract
STUDY DESIGN: Cross-sectional survey. OBJECTIVE: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. METHODS: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. RESULTS: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. CONCLUSIONS: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.