Additional research priorities
11.What are the main signs and symptoms that people with DCM present with? What is the frequency, sensitivity, specificity, and positive predictive value of symptoms and signs (clinical assessments) for DCM? |
12.What is the optimal follow-up for people with DCM managed conservatively and surgically? What is the appropriate follow-up for people with DCM or those with spinal cord compression but no myelopathy? Who should follow these individuals? How often should new imaging be obtained? How should changes in neurological status be documented or addressed? |
13.What are the most effective therapies for treatment of specific symptoms of DCM and the prevention of associated complications in DCM, including spasticity, imbalance and sensory, bladder or bowel dysfunction? |
14.What are the factors that predict the development of myelopathy in people with evidence of spinal cord compression and no symptoms? |
15.What are the most important determinants of functional outcomes, quality of life and patient satisfaction following surgical or non-operative treatment for DCM? |
16.What clinical and/or imaging features are predictive of neurological deterioration in people with DCM? Are there certain features that indicate irreversible disease? |
17.What are the risk factors for the development or progression of DCM, including but not limited to, lifestyle, diet, exercise, posture, occupation, history of trauma and coexistent disease? Does their modification have a role in prevention or treatment? |
18.What is the ideal timing for surgical intervention? |
19.What is the efficacy and safety of non-operative treatment in the management of DCM compared with surgical treatment? Can non-operative treatment avoid the need for surgery long-term? When can a “watch and wait” approach be adopted? |
20.What are the most effective therapies for treating pain in people with DCM? |
21.What is the preferred management strategy for people with mild DCM? What is the most cost-effective management strategy in this cohort? Are there clinical and imaging features that predict who should undergo surgical decompression and/or when? |
22.Can Cerebrospinal fluid (CSF) or serum biomarkers be identified to support early diagnosis of DCM, and/or predict treatment outcomes? |
23.What lifestyle modifications (such as physical activity or exercise) are required or should be recommended to people with DCM to support recovery, avoid deterioration and improve quality of life? |
24.What is the role of surgery in the management of people with imaging evidence of cord compression but no specific features of myelopathy? Is this decision impacted by signal change on T2-weighted MRI images or the presence of neck pain? |
25.What treatments should be implemented following surgery and continued in the long-term? Is there a role for extended rehabilitation and exercise programs? What should be its frequency, content and duration, and whom should it be coordinated by? |
26.What is the incidence of adjacent segment degeneration following surgery for DCM? Are there strategies that can reduce the incidence? |
The process
The process brought together insights from all stakeholders, surgeons, health professionals, and people living with DCM, to be sure the questions represent what matters most.
The process adhered to the JLA methodology: 3'404 research ideas were gathered from 429 individuals (231 Surgeons, 99 Healthcare Professionals (HCP), 99 People with DCM or their supporters) using an online survey.
These were refined to produce 74 unanswered summary questions, which were prioritized in a second survey by 417 participants (214 Surgeons, 310 HCP, 107 People with DCM or their supporters).
The top 7 unique questions per stakeholder group (20 questions) and a further 6 questions selected by the AO Spine RECODE Steering Committee, entered a face-to-face consensus meeting in New York. This was attended by 25 individuals (7 Surgeons, 6 HCP, 11 People with DCM and 1 Supporter) where the top 10 priorities for research were agreed (panel).
