Current Trends in Degenerative Cervical Myelopathy

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 9-19 | Nandan Marathe, Shivakumar Bali, Rudra Prabhu, Harsh Agarwal, Atif Naseem, Akash Shakya, Ayush Sharma


Author: Nandan Marathe [1], Shivakumar Bali [2], Rudra Prabhu [3], Harsh Agarwal [4], Atif Naseem [4], Akash Shakya [4], Ayush Sharma [4]

[1] Department of Orthopaedics, Consultant Spine Surgeon, Chaitanya Spine Clinic, India

[2] Department of Orthopaedics, ASSI Spine Fellow, Stavya Spine Hospital and Research Institute, India

[3] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, India

[4] Department of Orthopaedic and Spine surgery Dr. Babasaheb Ambedkar Central Railway Hospital, India


Address of Correspondence
Dr. Ayush Sharma- D. Ortho, DNB, MS, Dip SICOT,
Department of Orthopaedic and Spine Surgery, Dr. Babasaheb Ambedkar Central Railway Hospital, Pune, India.


Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them. Through this review article, we hope to provide the readers with an insight into the present state of art in cervical myelopathy and what the future has in store for us.

Keywords: Cervical myelopathy, DTI, ADR, hybrid, laminoplasty, JOA


  1. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: Epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976) 2015;40:E675-93.
  2. Martin AR, Tadokoro N, Tetreault L, Arocho-Quinones EV, Budde MD, Kurpad SN, et al. Imaging evaluation of degenerative cervical myelopathy: Current state of the art and future directions. Neurosurg Clin North Am 2018;29:33-45.
  3. Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, et al. The aging of the global population: The changing epidemiology of disease and spinal disorders. Neurosurgery 2015;77 Suppl 4:S1-5.
  4. Nouri A, Martin AR, Mikulis D, Fehlings MG. Magnetic resonance imaging assessment of degenerative cervical myelopathy: A review of structural changes and measurement techniques. Neurosurg Focus 2016;40:E5.
  5. Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, et al. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin 2015;10:192-238.
  6. Leitch JK, Figley CR, Stroman PW. Applying functional MRI to the spinal cord and brainstem. Magn Reson Imaging 2010;28:1225-33.
  7. Tam S, Barry RL, Bartha R, Duggal N. Changes in functional magnetic resonance imaging cortical activation after decompression of cervical spondylosis: Case report. Neurosurgery 2010;67:E863-4; discussion E864.
  8. Bhosale S, Marathe NA, Marathe N, Bhide P. Diffusion tensor imaging as an additional post-operative prognostic predictor factor in cervical myelopathy patients: An observational study. J Craniovertebr Junction Spine 2019;10:10-3.
  9. Ellingson BM, Salamon N, Hardy AJ. Prediction of neurological impairment in cervical spondylotic myelopathy using a combination of diffusion MRI and proton MR spectroscopy. PloS One 2015;10:e0139451.
  10. Srivastava SK, Marathe N, Raj A, Bhosale S, Dhole K. Surgical management of Hirayama disease: A rare entity with unusual clinical features. Asian J Neurosurg 2020;15:405-8.
  11. Kolcun JP, Chieng LO, Madhavan K, Wang MY. The role of dynamic magnetic resonance imaging in cervical spondylotic myelopathy. Asian Spine J 2017;11:1008-15.
  12. Zdunczyk A, Schwarzer V, Mikhailov M. The corticospinal reserve capacity: Reorganization of motor area and excitability as a novel pathophysiological concept in cervical myelopathy. Neurosurgery 2017;83:810-8.
  13. Laliberte AM. An Examination of the Role of MicroRNA-21 in the Pathobiology of Degenerative Cervical Myelopathy Using Human and Animal Data. Toronto: Institute of Medical Science, University of Toronto; 2018.
  14. Fehlings BK, Badhiwala J, Ahn H, Farhadi HF, Shaffrey CI, Nassr A, et al. The safety and efficacy of riluzole in enhancing clinical outcomes in patients undergoing surgery for cervical spondylotic myelopathy: Results of the CSM-Protect double-blinded, multicentre randomized controlled trial in 300 patients.Can J Surg 2019;62 4 Suppl 1:S46.
  15. Sharma A, Marathe N, Aggarwal R, Singh V, Shakya A, Kamble P, et al. Prospective randomized control pilot study to compare the role of injection cerebrolysin in operated cases of degenerative cervical myelopathy. Spine (Phila Pa 1976) 2022;47:E58-63.
  16. Jeyamohan SB, Kenning TJ, Petronis KA. Effect of steroid use in anterior cervical discectomy and fusion: A randomized controlled trial. J Neurosurg Spine 2015;23:137-43.
  17. Aljabi Y, El-Shawarby A, Cawley DT. Effect of epidural methylprednisolone on post-operative pain and length of hospital stay in patients undergoing lumbar microdiscectomy. Surgeon 2015;13:245-9.
  18. Ghasemi M, Masaeli A, Rezvani M. Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo controlled trial. J Res Med Sci 2013;18 Suppl 1:S43-6.
  19. Villavicencio AT, Rajpal S, Nelson EL, Beasley K, Kantha V, Burneikiene S. Local retropharyngeal space anesthetic for dysphagia reduction after anterior cervical discectomy and fusion surgery: A single-center, prospective, randomized, double-blinded, placebo-controlled clinical trial. World Neurosurg 2021;146:e1377-83.
  20. Lo YL, Cheong PW, George JM, Tan SB, Yue WM, Guo CM, et al. Pregabalin and radicular pain study (PARPS) for cervical spondylosis in a multiracial Asian population. J Clin Med Res 2014;6:66-71.
  21. Walsh AJ, Bradford DS, Lotz JC. In vivo growth factor treatment of degenerated intervertebral discs. Spine (Phila Pa 1976) 2004;29:156-63.
  22. Paul R, Haydon RC, Cheng H, Ishikawa A, Nenadovich N, Jiang W, et al. Potential use of Sox9 gene therapy for intervertebral degenerative disc disease. Spine (Phila Pa 1976) 2003;28:755-63.
  23. Meisel HJ, Ganey T, Hutton WC, Libera J, Minkus Y, Alasevic O. Clinical experience in cell-based therapeutics: Intervention and
    outcome. Eur Spine J 2006;15 Suppl 3:S397-405.
  24. Wang Z, Perez-Terzic CM, Smith J, Mauck WD, Shelerud RA, Maus TP, et al. Efficacy of intervertebral disc regeneration with stem cells a systematic review and meta-analysis of animal controlled trials. Gene 2015;564:1-8.
  25. Zhang Y, Tao H, Gu T. The effects of human Wharton’s jelly cell transplantation on the intervertebral disc in a canine disc degeneration model. Stem Cell Res Ther 2015;6:154.
  26. Ahn J, Park EM, Kim BJ. Transplantation of human Whartonantation on the intervertebral disc in a canine disc degeneration model. . neration model. ective, randomized, doStem Cell Res Ther 2015;6:190.
  27. Wilson J, Jiang F, Fehlings M. Clinical predictors of complications and outcomes in degenerative cervical myeloradiculopathy. Indian Spine J 2019;2:59-67.
  28. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: Outcome after anterior or posterior decompression. J Neurosurg Spine 2009;11:521-8.
  29. Shamji MF, Mohanty C, Massicotte EM, Fehlings MG. The association of cervical spine alignment with neurologic recovery in a prospective cohort of patients with surgical myelopathy: Analysis of a series of 124 cases. World Neurosurg 2016;86:112-9.
  30. McClelland S 3rd, Oren JH, Protopsaltis TS, Passias PG. Outpatient anterior cervical discectomy and fusion: A metaanalysis. J Clin Neurosci 2016;34:166-8.
  31. George B, Gauthier N, Lot G. Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion. Neurosurgery 1999;44:81-90.
  32. Nandyala SV, Marquez-Lara A, Fineberg SJ, Singh K. Comparison of revision surgeries for one to two-level cervical TDR and ACDF from 2002 to 2011. Spine J 2014;14:2841-6.
  33. Laratta JL, Shillingford JN, Saifi C, Riew KD. Cervical disc arthroplasty: A comprehensive review of single-level, multi-level, and  hybrid procedures. Global Spine J 2018;8:78-83.
  34. Youssef JA, Heiner AD, Montgomery JR, Tender GC, Lorio MP, Morreale JM, et al. Outcomes of posterior cervical fusion and decompression: Asystematic review and meta-analysis. Spine J 2019.
  35. Luo W, Li Y, Zhao J, Zou Y, Gu R, Li H. Skip Laminectomy compared with laminoplasty for cervical compressive myelopathy: A systematic review and meta-analysis. World Neurosurg 2018;120:296-301.
  36. D’Andrea K, Dreyer J, Fahim DK. Utility of preoperative magnetic resonance imaging coregistered with intraoperative computed tomographic scan for the resection of complex tumors of the spine. World Neurosurg 2015;84:1804-15.
  37. Sharma A Sr. Does elevated mean arterial pressure lead to better outcomes in degenerative cervical myelopathy: A prospective, pilot randomized control trial. Spine J 2021;21:S118.
  38. Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and robotics in spinal surgery: Where are we now? Neurosurgery 2017;80:S86-99.
  39. Roser F, Tatagiba M, Maier G. Spinal robotics: Current applications and future perspectives. Neurosurgery 2013;72:12-8.
  40. Diaz-Aguilar LD, Hassan O, Pham MH. Minimally invasive robotic cervicothoracic fusion: A case report and review of literature. AME Case Rep 2021;5:24.
  41. Yue JJ, Long W. Full endoscopic spinal surgery techniques: Advancements, indications, and outcomes. Int J Spine Surg 2015;9:17.
  42. Wan Q, Zhang D, Li S. Posterior percutaneous full-endoscopic cervical discectomy under local anesthesia for cervical radiculopathy due to soft-disc herniation: A preliminary clinical study. J Neurosurg Spine 2018;29:351-7.
  43. Zhang C, Li D, Wang C, Yan X. Cervical endoscopic laminoplasty for cervical myelopathy. Spine 2016;41:B44-51.
  44. Saringer W, Nöbauer I, Reddy M, Tschabitscher M, Horaczek A. Microsurgical anterior cervical for aminotomy (uncoforaminotomy ) for unilateral radiculopathy: Clinical results of a new technique. Acta Neurochir 2002;144:685-94.
  45. Du Q, Wang X, Qin JP. Percutaneous full-endoscopic anterior transcorporeal procedure for cervical disc herniation: A novel procedure and early follow-up study. World Neurosurg 2018;112:e23-30.
  46. Vergara P, Timofeev I. Minimally invasive anterior cervical discectomy and fusion: A valid alternative to open techniques. Acta Neurochir (Wien) 2018;160:2467-71.
  47. Quillo-Olvera J, Lin GX, Suen TK, Jo HJ, Kim JS, et al. Anterior transcorporeal tunnel approach for cervical myelopathy guided
    by CT-based intraoperative spinal navigation: Technical note. J Clin Neurosci 2018;48:218-23.
  48. Robbins MM, Vaccaro AR, Madigan L. The use of bioabsorbable implants in spine surgery. Neurosurg Focus 2004;16:E1.
  49. Oskouian RJ, Whitehill R, Samii A, Shaffrey ME, Johnson JP, Shaffrey CI. The future of spinal arthroplasty: A biomaterial perspective. Neurosurg Focus 2004;17:E2.
  50. Kawanabe Y, Fujimoto M, Sato T. Cervical open-door laminoplasty by hydroxyapatite implant insertion without suturing. Neurospine 2018;15:362-7.
  51. Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2013;38 22 Suppl 1:S21-36.
  52. Karadimas SK, Gatzounis G, Fehlings MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015;24 Suppl
  53. Taylor AR. Mechanism and treatment of spinal-cord disorders associated with cervical spondylosis. Lancet 1953;1:717-20.
  54. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: The clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 2013;19:409-21.
  55. Hirai T, Uchida K, Nakajima H, Guerrero AR, Takeura N, Watanabe S, et al. The prevalence and phenotype of activated microglia/macrophages within the spinal cord of the hyperostotic mouse (twy/twy) changes in response to chronic progressive spinal cord compression: Implications for human cervical compressive myelopathy. PLoS One 2013;8:e64528.
  56. Agrawal SK, Fehlings MG. Mechanisms of secondary injury to spinal cord axons in vitro: Role of Na+, Na(+)-K(+)- ATPase, the
    Na(+)-H+ exchanger, and the Na(+)-Ca2+ exchanger. J Neurosci 1996;16:545-52.
  57. Regan RF, Choi DW. Glutamate neurotoxicity in spinal cord cell culture. Neuroscience 1991;43:585-91.
  58. Kopjar B, Tetreault L, Kalsi-Ryan S, Fehlings M. Psychometric properties of the modified Japanese orthopaedic association scale in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2015;40:E23-8.
  59. Singh A, Crockard HA. Comparison of seven different scales used to quantify severity of cervical spondylotic myelopathy and post-operative improvement. J Outcome Meas 2001- 2002;5:798-818.
  60. Kalsi-Ryan S, Singh A, Massicotte EM, Arnold PM, Brodke DS, Norvell DC, et al. Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2013;38 22 Suppl 1:S111-22.
  61. Badhiwala JH, Hachem LD, Merali Z, Witiw CD, Nassiri F, Akbar MA, et al. Predicting outcomes after surgical decompression for
    mild degenerative cervical myelopathy: Moving beyond the mJOA to identify surgical candidates. Neurosurgery 2020;86:565-73.
  62. Khan O, Badhiwala JH, Witiw CD, Wilson JR, Fehlings MG. Machine learning algorithms for prediction of health-related quality-of-life after surgery for mild degenerative cervical myelopathy. Spine J 2021;21:1659-69.
  63. Chen G, Wei F, Shi L, Li J, Wang X, Wang M, et al. Inadequate spinal cord expansion in intraoperative ultrasound after decompression may predict neurological recovery of degenerative cervical myelopathy. Eur Radiol 2021;31:8478- 87.
  64. Davies BM, Khan DZ, Mowforth OD, McNair AG, Gronlund T, Kolias AG, et al. RE-CODE DCM (REsearch objectives and common data elements for degenerative cervical myelopathy): A consensus process to improve research efficiency in DCM, through establishment of a standardized dataset for clinical research and the definition of the research priorities. Global Spine J 2019;9 Suppl 1:65S-76.
  65. Hejrati N, Moghaddamjou A, Marathe N, Fehlings MG. Degenerative cervical myelopathy: Towards a personalized approach. Can J Neurol Sci 2021;1-12.


How to Cite this article: Marathe N, Bali S, Prabhu R, Agarwal H, Naseem A, Shakya A, Sharma A. Current Trends in Degenerative Cervical Myelopathy. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):9-19.

 (Abstract    Full Text HTML)   (Download PDF)