title: Degenerative cervical myelopathy.
abstract: Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.
authors.affiliation: Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.affiliation: Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. michael.fehlings@uhn.ca.|Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. michael.fehlings@uhn.ca.|Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T2S8, Canada. michael.fehlings@uhn.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Fehlings
keywords: Adjuvant therapy; Approach; Degenerative cervical myelopathy; Non-surgical treatment; Prognosis; Surgical treatment