Priority 12 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What is the optimal follow-up for patients managed conservatively and surgically? What is the appropriate follow-up for patients with DCM or those with spinal cord compression but no myelopathy symptoms? Who should be responsible for following these patients? How often should new imaging be obtained? How should changes in neurologic status be documented or addressed? (JLA PSP Priority 12)
Overall ranking	12
JLA question ID	0097/12
Explanatory note	It is important that patients with DCM be followed up appropriately and assessed at regular intervals for any change in neurological status. There is no treatment protocol that outlines the optimal follow-up for patients managed conservatively and surgically. An algorithm is needed to define the appropriate timing of follow-up, who should be responsible for assessing these patients and how often new imaging should be obtained.
Evidence	No systematic reviews, scoping reviews or guidelines identified
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Which is the best way to follow patients surgically treated for DCM? ~ What is the appropriate follow-up/surveillance for patients with spinal cord compression but no myelopathy symptoms or mild myelopathy symptoms? ~ If a patient has mild DCM on imaging studies, do we need to follow up with regular imaging studies to monitor the progression? How often? ~ How can primary care be involved in this care? How long should follow up be performed? ~ Should adjacent disc levels be monitored with MRI after surgical treatment of DCM? How often should the MRI be performed? What are the best time frames to monitor non operative patients? ~ What are the imaging recommendations for monitoring DCM?
Submitted by	Spinal Surgeons x 58, Other healthcare professionals x 29, People with DCM and their supporters x 26

Extra information provided by this PSP

Original uncertainty examples

Which is the best way to follow patients surgically treated for DCM? ~ What is the appropriate follow-up/surveillance for patients with spinal cord compression but no myelopathy symptoms or mild myelopathy symptoms? ~ If a patient has mild DCM on imaging studies, do we need to follow up with regular imaging studies to monitor the progression? How often? ~ How can primary care be involved in this care?
How long should follow up be performed? ~ Should adjacent disc levels be monitored with MRI after surgical treatment of DCM? How often should the MRI be performed?
What are the best time frames to monitor non operative patients? ~ What are the imaging recommendations for monitoring DCM?

Submitted by

Spinal Surgeons x 58, Other healthcare professionals x 29, People with DCM and their supporters x 26

PSP information
PSP unique ID	0097
PSP name	Degenerative Cervical Myelopathy
Total number of uncertainties identified by this PSP.	76 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	20 November 2019