Improving Assessment of Disease Severity and Strategies for Monitoring Progression in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 4]

Abstract

Study design Narrative Review. Objective To (i) discuss why assessment and monitoring of disease progression is critical in Degenerative cervical myelopathy (DCM); (ii) outline the important features of an ideal assessment tool and (iii) discuss current and novel strategies for detecting subtle deterioration in DCM. Methods Literature review Results Degenerative cervical myelopathy is an overarching term used to describe progressive injury to the cervical spinal cord by age-related changes of the spinal axis. Based on a study by Smith et al (2020), the prevalence of DCM is approximately 2.3% and is expected to rise as the global population ages. Given the global impact of this disease, it is essential to address important knowledge gaps and prioritize areas for future investigation. As part of the AO Spine RECODE-DCM (Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy) project, a priority setting partnership was initiated to increase research efficiency by identifying the top ten research priorities for DCM. One of the top ten priorities for future DCM research was: What assessment tools can be used to evaluate functional impairment, disability and quality of life in people with DCM? What instruments, tools or methods can be used or developed to monitor people with DCM for disease progression or improvement either before or after surgical treatment? Conclusions With the increasing prevalence of DCM, effective surveillance of this population will require both the implementation of a monitoring framework as well as the development of new assessment tools.

Development of a core measurement set for research in degenerative cervical myelopathy: a study protocol (AO Spine RECODE-DCM CMS)

“…From the outset, it was decided that the CMS would principally focus on existing instruments currently in use. Although the development of better assessment instruments is a top 10 research priority, 27 the strategy to use existing instruments was preferred for several reasons. First, the aim of this project was to develop a CMS that could be immediately implemented in clinical practice and research studies.…”

“…First, the aim of this project was to develop a CMS that could be immediately implemented in clinical practice and research studies. The development of new tools remains a work in progress, including microstructural MRI, gait laboratory analysis and clinical assessments 27 30 61. While it seems inevitable that these measurement instruments will change DCM assessment, there remain important methodological uncertainties, practical challenges and technological requirements that pose potential barriers to adoption.…”

“…However, the research priority-setting process further recognised a need to develop new measurement instruments for DCM. 27 Acknowledging that such development demands a significant period of time and financial support, it was decided that the initial CMS should focus on selecting the most relevant—but existing—instruments, as opposed to developing new tools or selecting those early in development. The added benefit would be to enable comparisons with historic data while simplifying the implementation of DCM’s first minimum dataset.…”

“…As outlined earlier, the standardisation of data measurement and reporting is an immediate priority for DCM. However, the research priority-setting process further recognised a need to develop new measurement instruments for DCM 27. Acknowledging that such development demands a significant period of time and financial support, it was decided that the initial CMS should focus on selecting the most relevant—but existing—instruments, as opposed to developing new tools or selecting those early in development.…”

“…So far, AO Spine RECODE-DCM has established the top research priorities and agreed on a single definition and index term 4 8 21–32. It has also agreed on ‘what’ should be measured in DCM research: that is, a minimum data set, which is comprised core data elements (CDE) and a core outcome set (COS).…”