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

Benjamin M. Davies, Oliver Mowforth, Aref Ali Gharooni, Lindsay Tetreault, Aria Nouri, Rana S. Dhillon, Josef Bednarik, Allan R. Martin, Adam Young, Hitoshi Takahashi, Timothy F. Boerger, Virginia F.J. Newcombe, Carl Moritz Zipser, Patrick Freund, Paul Aarne Koljonen, Ricardo Rodrigues-Pinto, Vafa Rahimi-Movaghar, Jefferson R. Wilson, Shekar N. Kurpad, Michael G. FehlingsBrian K. Kwon, James S. Harrop, James D. Guest, Armin Curt, Mark R.N. Kotter

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)78S-96S
JournalGlobal Spine Journal
Volume12
Issue number1_suppl
DOIs
StatePublished - Feb 2022
Externally publishedYes

Keywords

  • cervical
  • degeneration
  • disability
  • disc herniation
  • myelopathy
  • ossification posterior longitudinal ligament
  • questionnaire
  • recovery
  • spondylosis
  • spondylotic
  • stenosis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this