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      Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management

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          Abstract

          The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.

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          Intervertebral Disk Degeneration and Repair.

          James E Dowdell, Mark Erwin, Theodoe Choma … (2017)
          Intervertebral disk (IVD) degeneration is a natural progression of the aging process. Degenerative disk disease (DDD) is a pathologic condition associated with IVD that has been associated with chronic back pain. There are a variety of different mechanisms of DDD (genetic, mechanical, exposure). Each of these pathways leads to a final common result of unbalancing the anabolic and catabolic environment of the extracellular matrix in favor of catabolism. Attempts have been made to gain an understanding of the process of IVD degeneration with in Vitro studies. These models help our understanding of the disease process, but are limited as they do not come close to replicating the complexities that exist with an in Vivo model. Animal models have been developed to help us gain further understanding of the degenerative cascade of IVD degeneration In Vivo and test experimental treatment modalities to either prevent or reverse the process of DDD. Many modalities for treatment of DDD have been developed including therapeutic protein injections, stem cell injections, gene therapy, and tissue engineering. These interventions have had promising outcomes in animal models. Several of these modalities have been attempted in human trials, with early outcomes having promising results. Further, increasing our understanding of the degenerative process is essential to the development of new therapeutic interventions and the optimization of existing treatment protocols. Despite limited data, biological therapies are a promising treatment modality for DDD that could impact our future management of low back pain.
          Article 0 comments Cited 190 times – based on 0 reviews     Review now
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            Intervertebral disc repair by autologous mesenchymal bone marrow cells: a pilot study.

            Graciela Orozco, Mercedes Alberca, R Soler … (2011)
            Degenerative disc disease may cause severe low-back pain, a large public health problem with significant economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Cell-based therapies may circumvent these problems and have exhibited encouraging results in vitro and in animal studies. We designed a pilot study to assess feasibility and safety and to obtain early indications on efficacy of treatment with mesenchymal stem cells (MSC) in humans. Ten patients with chronic back pain diagnosed with lumbar disc degeneration with intact annulus fibrosus were treated with autologous expanded bone marrow MSC injected into the nucleus pulposus area. Clinical evolution was followed for 1 year and included evaluation of back pain, disability, and quality of life. Magnetic resonance imaging measurements of disc height and fluid content were also performed. Feasibility and safety were confirmed and strong indications of clinical efficacy identified. Patients exhibited rapid improvement of pain and disability (85% of maximum in 3 months) that approached 71% of optimal efficacy. This outcome compares favorably with the results of other procedures such as spinal fusion or total disc replacement. Although disc height was not recovered, water content was significantly elevated at 12 months. MSC therapy may be a valid alternative treatment for chronic back pain caused by degenerative disc disease. Advantages over current gold standards include simpler and more conservative intervention without surgery, preservation of normal biomechanics, and same or better pain relief.
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              Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder.

              Spyridon K. Karadimas, Sarbjeet S. Kalsi, Michael Fehlings (2013)
              Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field.
              Article 0 comments Cited 118 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurospine
                Journal ID (iso-abbrev): Neurospine
                Journal ID (publisher-id): NS
                Title: Neurospine
                Publisher: Korean Spinal Neurosurgery Society
                ISSN (Print): 2586-6583
                ISSN (Electronic): 2586-6591
                Publication date (Print): September 2019
                Publication date (Electronic): 26 August 2019
                Volume: 16
                Issue: 3
                Pages: 494-505
                Affiliations
                [1 ]Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
                [2 ]Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
                Author notes
                Corresponding Author Michael G. Fehlings https://orcid.org/0000-0002-5722-6364 Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University Health Network, 399 Bathurst St., Suite 4W-449, Toronto, ON, Canada Tel: +1-416-603-5627 Fax: +1-416-603-5298 E-mail: michael.fehlings@ 123456uhn.ca
                Author information
                http://orcid.org/0000-0002-5722-6364
                Article
                Publisher ID: ns-1938314-157
                DOI: 10.14245/ns.1938314.157
                PMC ID: 6790745
                PubMed ID: 31476852
                SO-VID: 4eac103a-a2ba-4b35-baba-c1d30db0a70c
                Copyright © Copyright © 2019 by the Korean Spinal Neurosurgery Society
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 August 2019
                Date revision received : 26 August 2019
                Date accepted : 26 August 2019
                Categories
                Subject: Review Article

                Keywords: degenerative cervical myelopathy,magnetic resonance imaging,biomarkers,surgery
                Data availability:
                Keywords: degenerative cervical myelopathy, magnetic resonance imaging, biomarkers, surgery

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