Publication details

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Authors	DAVIES Benjamin M MOWFORTH Oliver GHAROONI Aref-Ali TETREAULT Lindsay NOURI Aria DHILLON Rana S BEDNAŘÍK Josef MARTIN Allan R YOUNG Adam TAKAHASHI Hitoshi BOERGER Timothy F NEWCOMBE Virginia F J ZIPSER Carl Moritz FREUND Patrick KOLJONEN Paul Aarne RODRIGUES-PINTO Ricardo RAHIMI-MOVAGHAR Vafa WILSON Jefferson R KURPAD Shekar N FEHLINGS Michael G KWON Brian K HARROP James S GUEST James D CURT Armin KOTTER Mark R N
Year of publication	2022
Type	Article in Periodical
Magazine / Source	GLOBAL SPINE JOURNAL
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://journals.sagepub.com/doi/10.1177/21925682211057546
Doi	http://dx.doi.org/10.1177/21925682211057546
Keywords	cervical; myelopathy; spondylosis; spondylotic; stenosis; disc herniation; ossification posterior longitudinal ligament; degeneration; disability; recovery; questionnaire
Description	Study Design: Literature Review (Narrative) Objective: To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. Methods: Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. Results: Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. Conclusion: Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.