Grant: Project Grant

Degenerative Cervical Myelopathy (DCM) is a common disorder which occurs when progressive age-related changes affecting the bones and discs in the neck lead to compression of the spinal cord, resulting in symptoms of hand weakness, walking difficulties and loss of bladder control. Patients with DCM are classified according to the severity of symptoms as either mild, moderate or severe. Given their significant disability, it is recommended that moderate and severe patients undergo spine surgery to help improve symptoms. In comparison, mild patients (most common type of DCM) experience much less disability; however, an unpredictable proportion of these patients (30-60%) will develop worsening symptoms without surgery, with the remaining fraction remaining stable or improving over time. Ideally, doctors would have a clear understanding of which mild patients are likely to deteriorate such that this fraction could be offered surgery to prevent worsening, while those likely to remain stable or improve could be closely monitored without surgery. Unfortunately, current studies do not provide such information. As a result, doctors have little to guide them when counseling mild DCM patients and making treatment recommendations. To facilitate improvements in understanding and care, 236 mild DCM patients treated without surgery will be enrolled at four Canadian hospitals and followed closely for up to 5 years, observing for changes in clinical status. At the outset, all patients will undergo comprehensive testing including hand function and walking assessments as well as MRI scans. At study completion, using statistics, we will identify which patient information predicts a higher likelihood of clinical deterioration. This information will then be used to help doctors customize treatment plans, with those patients calculated to be at high risk of future deterioration given a recommendation of surgery.