From the Guidelines
Degenerative cervical myelopathy can progress after surgical intervention in some patients, with approximately 15-20% of patients experiencing continued deterioration or recurrence of symptoms after surgery. This progression can occur due to several factors, including incomplete decompression during the initial surgery, development of new compression at adjacent levels (adjacent segment disease), persistent spinal cord damage that was irreversible, or the natural progression of the underlying degenerative process 1.
Factors Contributing to Progression
- Incomplete decompression during the initial surgery
- Development of new compression at adjacent levels (adjacent segment disease)
- Persistent spinal cord damage that was irreversible
- The natural progression of the underlying degenerative process
Monitoring for Progression
Patients who undergo surgery typically have follow-up appointments at regular intervals (usually at 6 weeks, 3 months, 6 months, and annually thereafter) to monitor for any signs of progression, such as worsening gait difficulties, increased hand clumsiness, new or worsening numbness, or bladder/bowel dysfunction. If progression is suspected, imaging studies such as MRI are typically performed to evaluate the surgical site and adjacent levels, as MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures 1.
Management of Progression
Some patients may require revision surgery or extension of the previous fusion if significant new compression is identified. MRI is useful for evaluation of the spinal cord when investigating the etiology of chronic or progressive myelopathy, and can identify spinal cord lesions suggestive of demyelinating disease in addition to excluding alternative causes of myelopathy 1.
From the Research
Degenerative Cervical Myelopathy Progression After Surgery
- The progression of degenerative cervical myelopathy (DCM) after surgical intervention is a complex topic that has been studied in various research papers 2, 3, 4, 5.
- According to a study published in the Journal of Clinical Orthopaedics and Trauma, surgical treatment is the gold standard for moderate to severe DCM, and the choice of surgical option depends on the pattern of spinal cord compression, sagittal alignment, and patient comorbidities 2.
- Another study published in Nature Reviews Neurology states that expeditious diagnosis and treatment of DCM are needed to avoid permanent disability, and surgical decompression is recommended for moderate and severe DCM 3.
- A retrospective study published in Spine found that surgery for DCM leads to significant functional improvement, but better outcomes were observed in younger individuals with lower comorbidity indexes and absence of radiographic myelopathy signs 4.
- A long-term follow-up study published in Neurosurgery demonstrated that patients undergoing surgery for DCM show persistence of statistically significant and clinically meaningful improvement across a wide range of patient-reported outcome measures 5.
- However, a preclinical study published in Stem Cell Research & Therapy found that cell-based therapies, such as bone marrow-derived marrow stromal cells, may not be efficacious as an adjunct to surgical decompression in DCM 6.
Factors Influencing Progression
- Age, comorbidity index, and presence of high signal intensity on T2-weighted MRI are independent predictors of lower pre- and postoperative modified Japanese Orthopaedic Association scores and postoperative minimum clinically important difference 4.
- Symptom duration does not influence neurological outcome according to the severity of DCM 4.
- The severity of DCM, as measured by the modified Japanese Orthopaedic Association score, can affect the outcome of surgery 4, 5.
Long-Term Outcomes
- Long-term follow-up of patients undergoing surgery for DCM demonstrates persistence of statistically significant and clinically meaningful improvement across a wide range of patient-reported outcome measures 5.
- The majority of patients report being stable or improved at long-term follow-up, with no significant changes in patient-reported outcome measures from 1 year to long-term follow-up 5.