Biological Basis

What is the pathophysiology of DCM? What are the mechanisms of neurological injury and the molecular and anatomical consequences?

Podcast Episode 5: Biological basis

Can pre-clinical research accelerate clinical trials in Degenerative Cervical Myelopathy and speed up finding solutions? A question for Episode 5 of the AO Spine RECODE-DCM podcast series: Understanding the Biological Basis. Benjamin Davies and Michelle Franklin talk with Mark Kotter, Prof James Fawcett, and Ellen Sarewitz, a Healthcare Communications expert living with DCM.

Current evidence and reason for uncertainties

No systematic reviews, scoping reviews or guidelines identified.

 

Several literature reviews identified on the topic, including

Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S21-36.

Source of uncertainty

  • Spinal surgeons

    12

  • Other healthcare professionals

    6

  • People with DCM and their supporters

    3

  • Original suggestions*

    * This list shows the original survey submission(s) that informed the indicative uncertainties and the resulting priority question.

    Causes of Degenerative cervical myopathy?

    Nature Neuronal Protective mechanism towards formation of DCM  Calcification related to degenerative problem or metabolism problem  Injury or joint dysfunction lead to calcification subsequently lead to DCM   Delayed OPLL in early fused segment- early fusion to avoid DCM

    What causes DCM? (genetic/molecular pathophysiology)

    What is the aetiology?

    What causes DCM

    What spinal cord pathological changes underlie motor and sensory deficits in CSM? 

    How does the OPLL generats?  What is the cause of OPLL ? WHAT is the pathological  differences between CSM and OPLL?

    What is the main etiologies of DCM? Environment versus Genetics? 

    What role does inflammation and its management play in the initial and subsequent presentations of DCM?  

    Why does DCM cause neurological impairment? What are the exact structures and neural pathways that are affected?

    Which is more influential on DCM events, whether pressure on the spinal cord tissue or pressure on the spinal cord vascularization

    Which pressure is the most frequent cause of Spinal Cord, is it bone, Ligamentum Flavum, Disc?

    What is the natural cause of DCM during a life span?

    Would like to know more about the disease process

    How different is the myelopathic cord from normal ones- micro anatomy and physiologically?

    Better understanding the pathphysiology and underlying mechanisms

    1. Were have always assumed that myelopathy is due to wear and tear due to micro-movements. Has this ever been demonstrated  in an experimental setting over a LONG PERIOD?  2. What exactly is the pathophysiological basis of the high signal seen in the cord at the site of compression?   3.

    Understanding of the underlying exact pathophysiologic mechanism

    Study factors lead to excessive calcification of non-bony structure

    Would love to investigate about biology of DCM

    Is the condition a form of arthritis ?