A protocol for developing screening criteria for degenerative cervical myelopathy: AO Spine Myelopathy.org RECODE-DCM

Abstract

Study design: Protocol Objectives: Degenerative cervical myelopathy (DCM) is caused by degenerative changes of the spinal column that lead to progressive spinal cord compression. Early identification of DCM is paramount to ensure appropriate specialist referral, timely intervention, and optimal treatment outcomes. Unfortunately, diagnosis of DCM is often delayed and may be missed entirely. A lack of screening or referral criteria has been identified as a major contributor of diagnostic delay. The objective of this study is to outline the methodology that will be used to develop screening criteria for DCM. Methods: We propose a three-step approach for establishing screening criteria for DCM using data-driven and expert-based methods that includes a combination of patient-reported symptoms and clinical signs obtained from physical examination. Our approach includes: (i) an initial scoping review of inclusion criteria used in DCM research studies; (ii) criteria generation through systematic reviews of the literature as well as surveys of individuals with lived experience and international multidisciplinary experts in DCM; and (iii) criteria reduction via a consensus process. Conclusions: Our framework intends to foster the development of valid, reliable and sustainable screening criteria that could improve awareness of DCM, influence practice decisions and reduce delays to diagnosis.