Current Concepts Diagnosis & Management—CSRS Supplement 2022The Natural History of Degenerative Cervical MyelopathyHouten, John K. MD*,†; Shahsavarani, Shaya MD*; Verma, Rohit B. MD* Author Information *Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Drive, Manhasset, NY †Division of Neurosurgery, Maimonides Medical Center, 10th Avenue Brooklyn NY The authors declare no conflicts of interest. Reprints: John K. Houten, MD, Director of Spinal Neurosurgery and Neurotrauma, 4802 Tenth Avenue, Brooklyn, NY 11219 (e-mail: [email protected]). Clinical Spine Surgery: December 2022 - Volume 35 - Issue 10 - p 396-402 doi: 10.1097/BSD.0000000000001405 Buy Metrics Abstract Degenerative cervical myelopathy (DCM) is the most frequent cause of spinal cord dysfunction and injury in the adult population and leads to significant loss of quality of life and economic impact from its associated medical care expenditures and loss of work. Surgical intervention is recommended for patients manifesting progressing neurological signs and symptoms of myelopathy, but the optimal management in individuals who have mild and clinically stable disease manifestations is controversial. Understanding the natural history of DCM is, thus, important in assessing patients and identifying those most appropriately indicated for surgical management. Despite the attempts to rigorously perform studies of the natural history of these patients, most published investigations suffer from methodological weaknesses or are underpowered to provide definitive answers. Investigations of particular patient subsets, however, provide some clinical guidance as to which patients stand most to benefit from surgery, and these may include those with lower baseline mJOA scores, evidence of segmental hypermobility, cord signal changes on MRI, abnormal somatosensory or motor-evoked potentials, or the presence of certain inflammatory markers. Clinicians should assess patients with mild myelopathy and those harboring asymptomatic cervical spinal cord compression individually when making treatment decisions and an understanding of the various factors that may influence natural history may aid in identifying those best indicated for surgery. Further investigations will likely identify how variables that affect natural history can be used in devising more precise treatment algorithms. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.