Degenerative cervical myelopathy (DCM) is one of the most frequent spinal cord disorders, although its natural history is poorly understood. The goal of this study was to look into functional outcomes in nonoperatively treated DCM patients, as well as the utility of quantitative clinical assessments and MRI to detect deterioration. Patients with newly diagnosed DCM or recurrent myelodysplastic syndrome (DCM) who were initially managed nonoperatively were included. Retrospective chart reviews were performed to analyze clinical outcomes and anatomical MRI scans for worsening compression or increased signal change. Quantitative neurological assessments were collected prospectively.
There were 117 patients in total (95 new diagnoses, 22 recurrent myelopathy), with 74 mild cases, 28 moderate cases, and 15 severe cases. 57 percent (95 percent CI 46 percent –67 percent) of newly diagnosed patients worsened neurologically over a 2.5-year follow-up period. Grip strength, GRASSP dexterity, and gait stability ratio were the best indicators of deterioration. The natural history of DCM looks to be poor; however, prospective investigations are needed to confirm this. The mJOA score, grip strength, dexterity, balance, and gait analysis should all be included in a series of evaluations. Clinical stability cannot be determined by the absence of deterioration on anatomical MRI or in mJOA scores.
Reference Link – https://thejns.org/spine/view/journals/j-neurosurg-spine/34/6/article-p821.xml
