Early versus late intervention for degenerative cervical myelopathy: what are the outcomes?—a review of the current literature

Abstract

Degenerative cervical myelopathy (DCM) is a condition resulting from chronic compression of the spinal cord in the cervical spine and the most common cause of spinal cord dysfunction in those greater than 50 years old. DCM can present with a myriad of different neurologic and autonomic symptoms. Some examples of common symptoms include gait and/or balance disturbances, loss of hand dexterity, neck stiffness and neck pain. The diagnosis of DCM can be difficult and is based on a combination of clinical evaluation and imaging. DCM is often progressive, and the gold standard for treatment of moderate-to-severe or progressive disease is surgical decompression of the involved spinal levels. The existing literature suggests that early surgical intervention is essential to minimizing long-term disability and maximizing quality of life. Regardless of the metric used for surgical timing (i.e., duration of symptoms or established disease severity criteria), patients with symptomatic and worsening DCM benefit from surgical decompression and can expect a halt in disease progression and at least some meaningful functional improvement. The objective of this article is to provide an overview of our current understanding of DCM’s pathophysiology, diagnosis, and management with a particular focus on intervention timing and how this may impact patient outcomes.