- Email: [email protected]
Current Knowledge in Degenerative Cervical Myelopathy
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P re f a c e C u r ren t K n o w l e d g e i n Degenerative Cervical Myelopathy
Michael G. Fehlings, MD, PhD Editor
Neurosurg Clin N Am - (2017) -–https://doi.org/10.1016/j.nec.2017.09.021 1042-3680/17/Ó 2017 Published by Elsevier Inc.
address the knowledge gaps associated with DCM, I felt it was the perfect time to partner with Neurosurgery Clinics of North America and compile a special issue on the topic. This issue is meant to inform clinical practitioners and researchers on the current state of DCM care and research. This DCM issue is a collection of 20 articles written by 46 researchers and surgeons with worldclass expertise in the field. The compiled articles form three broad topic areas, which are meant to summarize current knowledge on the topic. 1. The first three articles describe the epidemiology, pathobiology, and natural history of DCM. A better understanding of the mechanisms of the disease builds the foundation for the following articles. 2. The focus then shifts to a discussion regarding the diagnosis of DCM. Here we explore the wide spectrum of causes of DCM and the specific tools and techniques used to diagnose patients, including radiographs, CT, and MR imaging. 3. Finally, the remaining twelve articles highlight the management of DCM in a variety of different scenarios dependent on disease severity and
neurosurgery.theclinics.com
In 2015, my research group formally introduced the term Degenerative Cervical Myelopathy (DCM) to describe myelopathy caused by various degenerative changes in the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. DCM is the leading cause of spinal cord dysfunction in adults, resulting in motor and sensory dysfunction, and significantly affecting a patient’s physical, psychological, and social well-being. The most common mechanisms involved in the pathobiology of DCM include apoptosis, inflammation, and vascular changes leading to loss of neurons, axonal degeneration, and myelin changes. The causes of DCM remain poorly understood, and the treatment of patients continues to be a significant health care challenge. The multifactorial nature of DCM poses an inherent challenge to clinicians, as the diagnosis and prognosis for the disease can vary greatly depending on the patient. Furthermore, there remains a great deal of controversy regarding optimal management practices for DCM, especially when considering the use of surgical interventions. To
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Preface cause. There is mounting evidence regarding the effectiveness of surgery for DCM in halting the progression of symptoms; however, surgical decision making relies on a weighing of the risks and benefits of alternative strategies, which are thoroughly discussed here. These articles complement work from the exciting field of DCM research, which has been very productive due to fruitful collaborations between researchers and clinicians. I have enjoyed serving as the editor for this issue, and it is my pleasure to share this work with you. I hope that the content compiled here will inform clinicians
and lead to a deeper understanding of DCM, ultimately resulting in improved patient outcomes.
Michael G. Fehlings, MD, PhD Department of Surgery University of Toronto Toronto Western Hospital University Health Network 399 Bathurst Street Toronto, Ontario M5T 2S8, Canada E-mail address: [email protected]
P re f a c e C u r ren t K n o w l e d g e i n Degenerative Cervical Myelopathy
Michael G. Fehlings, MD, PhD Editor
Neurosurg Clin N Am - (2017) -–https://doi.org/10.1016/j.nec.2017.09.021 1042-3680/17/Ó 2017 Published by Elsevier Inc.
address the knowledge gaps associated with DCM, I felt it was the perfect time to partner with Neurosurgery Clinics of North America and compile a special issue on the topic. This issue is meant to inform clinical practitioners and researchers on the current state of DCM care and research. This DCM issue is a collection of 20 articles written by 46 researchers and surgeons with worldclass expertise in the field. The compiled articles form three broad topic areas, which are meant to summarize current knowledge on the topic. 1. The first three articles describe the epidemiology, pathobiology, and natural history of DCM. A better understanding of the mechanisms of the disease builds the foundation for the following articles. 2. The focus then shifts to a discussion regarding the diagnosis of DCM. Here we explore the wide spectrum of causes of DCM and the specific tools and techniques used to diagnose patients, including radiographs, CT, and MR imaging. 3. Finally, the remaining twelve articles highlight the management of DCM in a variety of different scenarios dependent on disease severity and
neurosurgery.theclinics.com
In 2015, my research group formally introduced the term Degenerative Cervical Myelopathy (DCM) to describe myelopathy caused by various degenerative changes in the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. DCM is the leading cause of spinal cord dysfunction in adults, resulting in motor and sensory dysfunction, and significantly affecting a patient’s physical, psychological, and social well-being. The most common mechanisms involved in the pathobiology of DCM include apoptosis, inflammation, and vascular changes leading to loss of neurons, axonal degeneration, and myelin changes. The causes of DCM remain poorly understood, and the treatment of patients continues to be a significant health care challenge. The multifactorial nature of DCM poses an inherent challenge to clinicians, as the diagnosis and prognosis for the disease can vary greatly depending on the patient. Furthermore, there remains a great deal of controversy regarding optimal management practices for DCM, especially when considering the use of surgical interventions. To
ii
Preface cause. There is mounting evidence regarding the effectiveness of surgery for DCM in halting the progression of symptoms; however, surgical decision making relies on a weighing of the risks and benefits of alternative strategies, which are thoroughly discussed here. These articles complement work from the exciting field of DCM research, which has been very productive due to fruitful collaborations between researchers and clinicians. I have enjoyed serving as the editor for this issue, and it is my pleasure to share this work with you. I hope that the content compiled here will inform clinicians
and lead to a deeper understanding of DCM, ultimately resulting in improved patient outcomes.
Michael G. Fehlings, MD, PhD Department of Surgery University of Toronto Toronto Western Hospital University Health Network 399 Bathurst Street Toronto, Ontario M5T 2S8, Canada E-mail address: [email protected]