Priority 17 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What are the risk factors for the development or progression of DCM, including but not limited to, lifestyle, diet, exercise, posture, occupation, history of trauma and co-existent disease? Does their modification have a role in prevention or treatment? (JLA PSP Priority 17)
Overall ranking	17
JLA question ID	0097/17
Explanatory note	A systematic review was conducted by Singh et al (2012) to determine important risk factors for the development of DCM. Important findings from this review included (i) a congenitally narrow spinal canal can be associated with the development of DCM; (ii) DCM may have a genetic component; and (iii) gender, working years and extension-strain occupation are not risk factors for a diagnosis of DCM. Unfortunately, these conclusions were based on very low level of evidence. Future studies are required to further explore the impact of lifestyle, diet, exercise, posture, occupation, history of trauma and co-morbidities on the development and progression of DCM.
Evidence	Singh A, Tetreault L, Fehlings MG, Fischer DJ, Skelly AC. Risk factors for development of cervical spondylotic myelopathy: results of a systematic review. Evid Based Spine Care J. 2012 Aug;3(3):35-42.
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	What activities or occupations contribute to the development of DCM? ~ What role does sleep position, choice of pillow or mattress play in the development of DCM? ~ Are there lifestyles linked to the risk of DCM development? ~ When is congenital stenosis a problem? ~ How can we confirm that it is the symptom generator? ~ Do all people with Klippel-Feil have DCM? ~ To what extent do work injuries precipitate symptomatic degenerative cervical myelopathy? ~ What are the risk factors for development of DCM? ~ Are there any modifiable risk factors for DCM?
Submitted by	Spinal Surgeons x 59, Other healthcare professionals x 42, People with DCM and their supporters x 27

Extra information provided by this PSP

Original uncertainty examples

What activities or occupations contribute to the development of DCM? ~ What role does sleep position, choice of pillow or mattress play in the development of DCM? ~ Are there lifestyles linked to the risk of DCM development? ~ When is congenital stenosis a problem? ~ How can we confirm that it is the symptom generator? ~ Do all people with Klippel-Feil have DCM? ~ To what extent do work injuries precipitate symptomatic degenerative cervical myelopathy? ~ What are the risk factors for development of DCM? ~ Are there any modifiable risk factors for DCM?

Submitted by

Spinal Surgeons x 59, Other healthcare professionals x 42, People with DCM and their supporters x 27

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