Pathophysiology and Repair Potential in Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a chronic spinal cord disorder caused by progressive compression leading to ischemia, cell death, inflammation, demyelination, and network reorganization. Unlike traumatic injury, DCM evolves over time, producing distributed pathology across the neuraxis and adaptive but limited neuroplastic responses. Functional deficits arise from both reversible axonal dysfunction and irreversible degeneration, creating a time-sensitive window for intervention. Surgical decompression remains the primary treatment, enabling partial recovery through restoration of perfusion and plasticity. Adjunctive strategies, including neuroprotection, neuromodulation, and remyelination therapies, with rehabilitation, represent promising approaches to enhance recovery by targeting residual neural circuits and the evolving repair environment.