AO Spine Clinical Practice Recommendations for Mild Degenerative Cervical Myelopathy: Contemporary Concepts

Study DesignLiterature review with critical appraisal and clinical recommendations.ObjectiveTo highlight contemporary concepts involving the management of mild degenerative cervical myelopathy (DCM) and facilitate integration into clinical practice.MethodsFour articles relating to mild DCM were selected and critically appraised. Clinical practice recommendations were developed and evaluated using the GRADE framework and expert opinion.ResultsBased on low evidence in the Tetreault et al paper, it is conditionally recommended that the severity of DCM should be based on the mJOA score with the following thresholds: mild (15-17), moderate (12-14), and severe (≤11). No clinical recommendation, based on very low level of evidence for the Al-Shawwa et al article, on the routine use of MRI parameters to predict neurological deterioration or guide decisions on timing of surgical intervention in mild DCM. With low quality evidence presented by Badhiwala et al, there is a conditional recommendation for surgery in mild DCM patients with high levels of baseline pain and Neck Disability Index scores. A conditional recommendation, based on very low quality of evidence in the Ozaki et al paper, is that patients should be counseled that upper extremity sensory deficits frequently persist after decompression and that angular-edged spinal cord deformity on axial MRI should be considered a risk factor for residual postoperative upper extremity sensory impairment.ConclusionsThe management of mild DCM is an evolving field. Using established nomenclature and understanding the nuances of clinical and radiographic presentation may allow for more appropriate counselling and surgical candidate selection.