Priority 15 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What are the most important determinants of functional outcomes, quality of life and patient satisfaction following surgical or non-operative treatment for DCM? (JLA PSP Priority 15)
Overall ranking	15
JLA question ID	0097/15
Explanatory note	Several systematic reviews have been conducted to evaluate important clinical and imaging predictors of outcomes in patients undergoing surgery for DCM. The most frequently studied predictors are preoperative myelopathy severity, duration of symptoms and age. Based on the results of these reviews, patients with a longer duration of symptoms and more severe myelopathy are likely to have worse surgical outcomes. With respect to age, several studies have indicated that elderly patients may not be able to translate neurological recovery into functional improvements as well as younger patients. However, other studies have failed to identify a significant relationship between age and surgical outcomes. Others predictors studied include gender, co-morbidities, smoking status, various signs and symptoms, pathology, race, body mass index and imaging parameters. In contrast, very few studies have assessed important predictors of outcomes in patients treated nonoperatively for DCM.
Evidence	Tetreault L, Palubiski LM, Kryshtalskyj M, Idler RK, Martin AR, Ganau M, Wilson JR, Kotter M, Fehlings MG. Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy: A Systematic Review of the Literature. Neurosurg Clin N Am. 2018 Jan;29(1):115-127.e35.
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	Does patient’s age influence the surgical treatment? ~ Are there factors which can predict the outcome of surgery? ~ What are the imaging features that predict outcome? Are there specific physical findings that are linked to better or worse outcomes? Are there specific bio markers that predict outcome? ~ What is a predictor for poor surgical outcome? Are there any predictive factors on imaging related to surgical outcome? ~ What is the effect of duration of symptoms and degree of neurological deficit on prognosis after surgical management of DCM? ~ Does myelomalacia predict irreversible DCM? ~ Do patients with myelomalacia continue to deteriorate despite adequate decompression in DCM? ~ What factors predict improved patient outcomes with non-surgical management?
Submitted by	Spinal Surgeons x 103, Other healthcare professionals x 21, People with DCM and their supporters x 8

Extra information provided by this PSP

Original uncertainty examples

Does patient’s age influence the surgical treatment? ~ Are there factors which can predict the outcome of surgery? ~ What are the imaging features that predict outcome? Are there specific physical findings that are linked to better or worse outcomes? Are there specific bio markers that predict outcome? ~ What is a predictor for poor surgical outcome?
Are there any predictive factors on imaging related to surgical outcome? ~ What is the effect of duration of symptoms and degree of neurological deficit on prognosis after surgical management of DCM? ~ Does myelomalacia predict irreversible DCM? ~ Do patients with myelomalacia continue to deteriorate despite adequate decompression in DCM? ~ What factors predict improved patient outcomes with non-surgical management?

Submitted by

Spinal Surgeons x 103, Other healthcare professionals x 21, People with DCM and their supporters x 8

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