Study Design: Literature review of key topics related to degenerative cervical myelopathy (DCM) with critical appraisal and clinical recommendations. Objective: This article summarizes several key current topics related to the management of DCM. Methods: Recent literature related to the management of DCM was reviewed. Four articles were selected and critically appraised. Recommendations were graded as Strong or Conditional. Results: Article 1: The Relationship Between pre-operative MRI Signal Intensity and outcomes. Conditional recommendation to use diffusion-weighted imaging MR signal changes in the cervical cord to evaluate prognosis following surgical intervention for DCM. Article 2: Efficacy and Safety of Surgery for Mild DCM. Conditional recommendation that surgery is a valid option for mild DCM with favourable clinical outcomes. Article 3: Effect of Ventral vs Dorsal Spinal Surgery on Patient-Reported Physical Functioning in Patients With Cervical Spondylotic Myelopathy: A Randomized Clinical Trial. Strong recommendation that there is equipoise in the outcomes of anterior vs posterior surgical approaches in cases where either technique could be used. Article 4: Machine learning-based cluster analysis of DCM phenotypes. Conditional recommendation that clinicians consider pain, medical frailty, and the impact on health-related quality of life when counselling patients. Conclusions: DCM requires a multidimensional assessment including neurological dysfunction, pain, impact on health-related quality of life, medical frailty and MR imaging changes in the cord. Surgical treatment is effective and is a valid option for mild DCM. In patients where either anterior or posterior surgical approaches can be used, both techniques afford similar clinical benefit albeit with different complication profiles.

Background: Up to 30% of patients with cancer continue to suffer from pain despite aggressive supportive care. The present study aimed to determine whether cordotomy can improve cancer pain refractory to interdisciplinary palliative care.Materials and Methods: In this randomized controlled trial, we recruited patients with refractory unilateral somatic pain, defined as a pain intensity (PI) ≥4, after more than three palliative care evaluations. Patients were randomized to percutaneous computed tomography-guided cordotomy or continued interdisciplinary palliative care. The primary outcome was 33% improvement in PI at 1 week after cordotomy or study enrollment as measured by the Edmonton Symptom Assessment Scale.Results: Sixteen patients were enrolled (nine female, median age 58 years). Six of seven patients (85.7%) randomized to cordotomy experienced >33% reduction in PI (median preprocedure PI = 7, range 6–10; 1 week after cordotomy median PI = 1, range 0–6; p = .022). Zero of nine patients randomized to palliative care achieved a 33% reduction in PI. Seven patients (77.8%) randomized to palliative care elected to undergo cordotomy after 1 week. All of these patients experienced >33% reduction in PI (median preprocedure PI = 8, range 4–10; 1 week after cordotomy median PI = 0, range 0–1; p = .022). No patients were withdrawn from the study because of adverse effects of the intervention.Conclusion: These data support the use of cordotomy for pain refractory to optimal palliative care. The findings of this study justify a large-scale randomized controlled trial of percutaneous cordotomy.

OBJECTIVE: Spinal cord stress/strain during neck motion contributes to spinal cord dysfunction in degenerative cervical myelopathy (DCM), yet the effect of surgery on spinal cord biomechanics is unknown. It is expected that motion-preserving and fusion surgeries for DCM will have distinct effects on spinal cord biomechanics. The aim of this study was to compare changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty using a patient-specific finite element model (FEM) for DCM. METHODS: A patient-specific FEM of the cervical spine and spinal cord was created using MRI from a subject with mild DCM. Multilevel laminectomy with fusion, laminectomy, and laminoplasty were simulated for DCM using the patient-specific FEM. Spinal cord von Mises stress and maximum principal strain during neck flexion-extension, lateral bending, and axial rotation were recorded. Segmental range of motion, intradiscal pressure, and capsular ligament strain were also measured. FEM outputs were calculated as a change with respect to the preoperative values and compared between the three models. RESULTS: Across the surgical levels, spinal cord stress increased after laminectomy for neck flexion (+50%), neck extension (+37.8%), and axial rotation (+23%). Similarly, spinal cord strain increased in neck extension (+118.4%) and axial rotation (+75.1%) after laminectomy. Laminoplasty was associated with greater spinal cord stress in neck flexion (+57.4%) and increased strain in lateral bending (+56.7%) and axial rotation (+20.9%). Compared with laminectomy and laminoplasty, spinal cord biomechanics for laminectomy with fusion revealed significantly reduced median extension stress (13.7 kPa vs 9.7 kPa, p = 0.03), lateral bending strain (0.01 vs 0.007, p = 0.007), axial rotation stress (3.7 kPa vs 2.1 kPa, p = 0.04), and axial rotation strain (0.017 vs 0.009, p = 0.04). CONCLUSIONS: Spinal cord strain decreased in neck flexion in all three models, yet spinal cord stress increased with neck flexion for laminectomy and laminoplasty. Changes in spinal cord biomechanics for laminoplasty parallel those for laminectomy with fusion except during neck flexion, lateral bending, and axial rotation. Compared with motion-preserving approaches such as laminectomy and laminoplasty, laminectomy with fusion was associated with the lowest spinal cord stress and strain in flexion-extension, lateral bending, and axial rotation of the neck.

Changes in demography and injury patterns have altered the profile and outcome of acute spinal cord injury (SCI) over time. This study sought to describe recent trends in epidemiology and early clinical outcomes using the multi-center North American Clinical Trial Network (NACTN) for Spinal Cord Injury Registry. All participants with blunt acute traumatic SCI ( n = 782) were grouped into three five-year time intervals from 2005 to 2019 (2005–2009, 2010–2014, and 2015–2019). Baseline demographics, clinical scores, medical co-morbidities, as well as early clinical outcomes were extracted. Categorical and continuous variables were analyzed to determine between-group differences. Subgroup analysis was performed for participants <50 and ≥50 years of age. Over the duration of the study period, there was an increase in age at presentation ( p = 0.0077) as well as a greater incidence of falls as the mechanism of injury. Participants who were ≥50 years of age were more likely to sustain incomplete SCI (<0.0003) and central cord syndrome (< 0.0001). In the most recent period (2015–2019), a greater proportion of NACTN participants underwent surgery within 24 h of injury (63% vs. 41% vs. 41%, p = 0.0001). There was a statistically significant increase in cardiac complications ( p < 0.0001) and decrease in pulmonary complications ( p < 0.0001) during the study period. Data from the NACTN registry shows that the age of participants with acute SCI is increasing, falls have become the major mechanism of injury, and central cord injury is becoming increasingly prevalent. While early surgical intervention for acute SCI is more common in recent years, cardiac complications are more prevalent while pulmonary complications are less prevalent.

OBJECTIVE: Delays in diagnosis are common in degenerative cervical myelopathy (DCM), and there is a need for additional objective assessments of spinal cord structure and function. The objective of this study was to profile serum protein biomarkers in DCM and determine their potential diagnostic and prognostic utility. METHODS: Patients with clinically diagnosed DCM (n = 20) and scheduled to undergo decompressive surgery were prospectively enrolled from July 2022 to August 2023. Serum neuronal and inflammatory proteins in the patients were quantified before surgery and 3 months after surgery. Serum protein levels were compared between the DCM patients and healthy controls (n = 10). Serum biomarkers were also related to pre- and postsurgical functional measures. RESULTS: DCM patients had a median age of 70 years, and healthy controls had a median age of 65 years. Presurgical neurofilament light chain (NfL; 30.2 vs 11.2 pg/ml, p = 0.01) and interleukin (IL)–6 (2.9 vs 1.2, p = 0.003) were significantly higher in DCM patients than in controls. Presurgical NfL, IL-6, and brain-derived neurotrophic factor (BDNF) best differentiated DCM and controls (p < 0.001). At 3 months after surgery, serum BDNF (p = 0.001), amyloid beta 42 (p = 0.042), and tumor necrosis factor alpha (p = 0.007) were significantly increased compared to presurgical values. Presurgical serum NfL was significantly associated with improvement in pinch strength after surgery (p = 0.03). Inflammatory biomarkers were linked to improvement in the neck pain–related disability and upper limb function. CONCLUSIONS: Presurgical serum levels of NfL, IL-6, and BDNF show potential as diagnostic markers for DCM. Presurgical serum biomarkers of neuronal damage and inflammation predict early postsurgical functional outcomes in DCM.