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Diagnosis, Heritability, and Outcome Assessment in Cervical Myelopathy: A Consensus Statement

Wilson, Jefferson R. MD*; Fehlings, Michael G. MD, PhD*; Kalsi-Ryan, Sukhvinder PT, PhD*; Shamji, Mohammed F. MD, PhD*; Tetreault, Lindsay A. HBSc*; Rhee, John M. MD; Chapman, Jens R. MD

doi: 10.1097/BRS.0b013e3182a7f4bf
Diagnosis, Work-Up, and Treatment Planning

This section of the cervical spondylotic myelopathy (CSM) Spine focus issue collates evidence related to diagnosis, outcome assessment, and genetics. Given that a variety of different disease states can present similarly, a guide for diagnosing and differentiating CSM from other neurological conditions is initially presented. Although the value of magnetic resonance imaging in diagnosing CSM is cemented, its value as a tool to predict future outcome is less well established. To this end, the existing evidence suggests that although increased T2 cord signal is of limited value, the pairing of high T2 signal with low T1 signal, or a high T2 to T1 signal ratio, is associated with a reduced potential for neurological recovery at follow-up. Outcome assessment in CSM is of paramount importance when monitoring patients’ clinical course or measuring the efficacy of therapeutic interventions. Here, the main outcome measures that have been used to assess patients with CSM are reviewed. At present, we recommend that clinicians acquire the modified Japanese Orthopaedic Association scale score and the Neck Disability Index on all patients with CSM at presentation and follow-up. Finally, in regard to genetics, the existing evidence seems to support the principle of an inherited predisposition to both CSM and ossification of the posterior longitudinal ligament. Although several genetic polymorphisms have been consistently associated with ossification of the posterior longitudinal ligament, no specific polymorphisms were consistently associated with CSM.

*University of Toronto, Toronto, Ontario, Canada

Emory University, Atlanta, GA; and

University of Washington, Seattle, WA.

Address correspondence and reprint requests to Michael G. Fehlings, MD, PhD, FRCS, University of Toronto, 27 King's College Circle, Toronto, Ontario, Canada M5S 1A1; E-mail:

Acknowledgment date: June 4, 2013. First revision date: July 12, 2013. Acceptance date: July 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America, Inc. Analytic support for this work was provided by Spectrum Research, Inc., with funding from the AOSpine North America.

Relevant financial activities outside the submitted work: support for travel, board membership, consultancy, royalties, grants/grants pending, stock/stock options, and payment for lectures.

© 2013 by Lippincott Williams & Wilkins