Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]

Benjamin M Davies; Oliver Mowforth; Helen Wood; Zahabiya Karimi; Iwan Sadler; Lindsay Tetreault; Jamie Milligan; Jamie R F Wilson; Sukhvinder Kalsi-Ryan; Julio C Furlan; Yoshiharu Kawaguchi; Manabu Ito; Carl Moritz Zipser; Timothy F Boerger; Alexander R Vaccaro; Rory K J Murphy; Mike Hutton; Ricardo Rodrigues-Pinto; Paul A Koljonen; James S Harrop; Bizhan Aarabi; Vafa Rahimi-Movaghar; Shekar N Kurpad; James D Guest; Jefferson R Wilson; Brian K Kwon; Mark R N Kotter; Michael G Fehlings

doi:10.1177/21925682211050927

Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]

Global Spine J. 2022 Feb;12(1_suppl):28S-38S. doi: 10.1177/21925682211050927.

Authors

Benjamin M Davies^{1

2}, Oliver Mowforth^{1

2}, Helen Wood¹, Zahabiya Karimi¹, Iwan Sadler¹, Lindsay Tetreault³, Jamie Milligan⁴, Jamie R F Wilson⁵, Sukhvinder Kalsi-Ryan^{6

7}, Julio C Furlan^{6

7}, Yoshiharu Kawaguchi⁸, Manabu Ito⁹, Carl Moritz Zipser¹⁰, Timothy F Boerger¹¹, Alexander R Vaccaro¹², Rory K J Murphy¹³, Mike Hutton¹⁴, Ricardo Rodrigues-Pinto^{15

16}, Paul A Koljonen¹⁷, James S Harrop¹⁸, Bizhan Aarabi¹⁹, Vafa Rahimi-Movaghar²⁰, Shekar N Kurpad¹¹, James D Guest²¹, Jefferson R Wilson²², Brian K Kwon²³, Mark R N Kotter^{1

2}, Michael G Fehlings²²

Affiliations

¹ Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK.
² Department of Neurosurgery, 151895University of Cambridge, Cambridge, UK.
³ Department of Neurology, Langone Health, Graduate Medical Education, 5894New York University, New York, NY, USA.
⁴ Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada.
⁵ Department of Neurosurgery, 12284University of Nebraska Medical Center, Omaha, NE, USA.
⁶ KITE Research Institute, 7961University Health Network, Toronto, ON, Canada.
⁷ Department of Medicine, Division of Physical Medicine and Rehabilitation, 7938University of Toronto, Toronto, ON, Canada.
⁸ Department of Orthopaedic Surgery, 34823University of Toyama, Toyama, Japan.
⁹ Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
¹⁰ University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland.
¹¹ Department of Neurosurgery, 5506Medical College of Wisconsin, Wauwatosa, WI, USA.
¹² Department of Orthopaedic Surgery, 387400Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
¹³ Department of Neurosurgery, St. Joseph's Hospital and Medical Center, 115467Barrow Neurological Institute, Phoenix, AZ, USA.
¹⁴ 159028Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
¹⁵ Department of Orthopaedics, Spinal Unit (UVM), 112085Centro Hospitalar Universitário Do Porto - Hospital de Santo António, Porto, Portugal.
¹⁶ 89239Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.
¹⁷ Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong, China.
¹⁸ Department of Neurological Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA.
¹⁹ Department of Neurosurgery, 1479University of Maryland School of Medicine, Baltimore, MD, USA.
²⁰ Department of Neurosurgery, Sina Trauma and Surgery Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran.
²¹ Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, 12235University of Miami, Miami, FL, USA.
²² Department of Surgery, Division of Neurosurgery, 7938University of Toronto, Toronto, ON, Canada.
²³ Department of Orthopedics, Vancouver Spine Surgery Institute, The University of British Columbia, Vancouver, BC, Canada.

Abstract

Study design: Literature Review (Narrative).

Objective: To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness.

Methods: Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM.

Results: DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (<2% of Amyotrophic Lateral Sclerosis or Multiple Sclerosis over the last 25 years). The transformation of stroke and acute coronary syndrome services, from a position of best supportive care with occasional surgery over 50 years ago, to avoidable disability today, represents transferable examples of success and potential opportunities for DCM. Central to this is raising awareness.

Conclusion: Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority.

Keywords: cervical; degenerative cervical myelopathy; disability; disc herniation; myelopathy; ossification posterior longitudinal ligament; policy; prioritization; research prioritization; review; spondylosis; spondylotic; stenosis.