What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator
Introduction: Evidence on degenerative cervical myelopathy (DCM) has frequently focussed on surgical management, overlooking the role of non-surgical clinicians. Their contributions in the patient journey remain largely underexplored in the literature. Research question: What is the role of non-surg...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000943 |
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| author | Rohil V. Chauhan Andreas K. Demetriades Timothy F. Boerger Justin M. Lantz Caroline Treanor Sukhvinder Kalsi-Ryan Vishal Kumar Lianne Wood Joshua Plener Nicky Wilson Maryse Fortin Carlo Ammendolia Annalena Paus Rana S. Dhillon Benjamin Davies Michael G. Fehlings David B. Anderson |
| author_facet | Rohil V. Chauhan Andreas K. Demetriades Timothy F. Boerger Justin M. Lantz Caroline Treanor Sukhvinder Kalsi-Ryan Vishal Kumar Lianne Wood Joshua Plener Nicky Wilson Maryse Fortin Carlo Ammendolia Annalena Paus Rana S. Dhillon Benjamin Davies Michael G. Fehlings David B. Anderson |
| author_sort | Rohil V. Chauhan |
| collection | DOAJ |
| description | Introduction: Evidence on degenerative cervical myelopathy (DCM) has frequently focussed on surgical management, overlooking the role of non-surgical clinicians. Their contributions in the patient journey remain largely underexplored in the literature. Research question: What is the role of non-surgical clinicians in the assessment and management of people with DCM? Material and methods: This narrative review synthesizes knowledge from a comprehensive MEDLINE search and the collective expertise of the RECODE-DCM Peri-Operative Rehabilitation Incubator, an expert working group hosted by Myelopathy.org. Key domains of non-surgical clinician involvement include: 1) early recognition and referral, 2) patient education, 3) pain management, 4) preoperative management, and 5) postoperative rehabilitation. Results: Timely DCM diagnosis depends on first-contact clinicians recognizing hallmark symptoms. In the absence of standardized screening criteria, tools like the modified Japanese Orthopaedic Association score can support early identification. Non-surgical clinicians educate patients with mild or non-myelopathic spinal cord compression to recognize signs of DCM progression, ensuring timely surgical consultation. These clinicians also play a multidisciplinary role in the biopsychosocial management of pain, incorporating pharmacological and non-pharmacological strategies to address nociceptive and neuropathic pain. While predictors of postoperative outcomes, such as disease severity, gait dysfunction and smoking, are known, evidence on preoperative optimization and prehabilitation remains limited. Emerging research highlights the benefits of early postoperative rehabilitation, including cervical range of motion and stabilization exercises, in improving 12-month postoperative outcomes. Discussion and conclusion: Non-surgical clinicians play an integral role in DCM management across the care continuum. A multidisciplinary, patient-centred approach is essential. Postoperative rehabilitation holds promise, but prospective trials are necessary to establish standardization and optimal strategies for clinical delivery. |
| format | Article |
| id | doaj-art-949fcb1724594f809beee3ebf2d29eda |
| institution | DOAJ |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-949fcb1724594f809beee3ebf2d29eda2025-08-20T02:58:19ZengElsevierBrain and Spine2772-52942025-01-01510427510.1016/j.bas.2025.104275What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubatorRohil V. Chauhan0Andreas K. Demetriades1Timothy F. Boerger2Justin M. Lantz3Caroline Treanor4Sukhvinder Kalsi-Ryan5Vishal Kumar6Lianne Wood7Joshua Plener8Nicky Wilson9Maryse Fortin10Carlo Ammendolia11Annalena Paus12Rana S. Dhillon13Benjamin Davies14Michael G. Fehlings15David B. Anderson16Auckland Spine Surgery Centre, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Akoranga Campus, Northcote, Private Bag, 92006, Auckland, New Zealand; Corresponding author. Auckland Spine Surgery Centre, Auckland, New Zealand.Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, the Netherlands; Department of Neurosurgery, Royal Infirmary, Edinburgh, UKMedical College of Wisconsin, Milwaukee, USADivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USANational Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, IrelandKITE Research Institute, University Health Network, Toronto, CanadaPostgraduate Institute of Medical Education and Research, Chandigarh, IndiaDepartment of Public Health and Sports Science, University of Exeter, Exeter, EX1 2LU, UKDepartment of Medicine, Mount Sinai Hospital, Toronto, CanadaPhysiotherapy Department, King's College Hospital NHS Foundation Trust, UK; London, UK & Centre for Rheumatic Disease, King's College London, London, UKDepartment of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, Qc, CanadaDepartment of Surgery, University of Toronto, Toronto, CanadaDepartment of Therapeutic Health Professions, University Hospital Münster, GermanyDepartment of Surgery, University of Melbourne, Victoria, Australia; Department of Neurosurgery, St Vincents Hospital Melbourne, Victoria, AustraliaDivision of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Myelopathy.org, Cambridge, UKDivision of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, CanadaSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Spine Institute, Burwood, Sydney, AustraliaIntroduction: Evidence on degenerative cervical myelopathy (DCM) has frequently focussed on surgical management, overlooking the role of non-surgical clinicians. Their contributions in the patient journey remain largely underexplored in the literature. Research question: What is the role of non-surgical clinicians in the assessment and management of people with DCM? Material and methods: This narrative review synthesizes knowledge from a comprehensive MEDLINE search and the collective expertise of the RECODE-DCM Peri-Operative Rehabilitation Incubator, an expert working group hosted by Myelopathy.org. Key domains of non-surgical clinician involvement include: 1) early recognition and referral, 2) patient education, 3) pain management, 4) preoperative management, and 5) postoperative rehabilitation. Results: Timely DCM diagnosis depends on first-contact clinicians recognizing hallmark symptoms. In the absence of standardized screening criteria, tools like the modified Japanese Orthopaedic Association score can support early identification. Non-surgical clinicians educate patients with mild or non-myelopathic spinal cord compression to recognize signs of DCM progression, ensuring timely surgical consultation. These clinicians also play a multidisciplinary role in the biopsychosocial management of pain, incorporating pharmacological and non-pharmacological strategies to address nociceptive and neuropathic pain. While predictors of postoperative outcomes, such as disease severity, gait dysfunction and smoking, are known, evidence on preoperative optimization and prehabilitation remains limited. Emerging research highlights the benefits of early postoperative rehabilitation, including cervical range of motion and stabilization exercises, in improving 12-month postoperative outcomes. Discussion and conclusion: Non-surgical clinicians play an integral role in DCM management across the care continuum. A multidisciplinary, patient-centred approach is essential. Postoperative rehabilitation holds promise, but prospective trials are necessary to establish standardization and optimal strategies for clinical delivery.http://www.sciencedirect.com/science/article/pii/S2772529425000943Degenerative cervical myelopathyNon-surgicalNonoperativeRehabilitationMultidisciplinary |
| spellingShingle | Rohil V. Chauhan Andreas K. Demetriades Timothy F. Boerger Justin M. Lantz Caroline Treanor Sukhvinder Kalsi-Ryan Vishal Kumar Lianne Wood Joshua Plener Nicky Wilson Maryse Fortin Carlo Ammendolia Annalena Paus Rana S. Dhillon Benjamin Davies Michael G. Fehlings David B. Anderson What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator Brain and Spine Degenerative cervical myelopathy Non-surgical Nonoperative Rehabilitation Multidisciplinary |
| title | What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator |
| title_full | What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator |
| title_fullStr | What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator |
| title_full_unstemmed | What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator |
| title_short | What is the role of non-surgical clinicians in the assessment and management of degenerative cervical myelopathy? – Insights from the RECODE-DCM peri-operative rehabilitation incubator |
| title_sort | what is the role of non surgical clinicians in the assessment and management of degenerative cervical myelopathy insights from the recode dcm peri operative rehabilitation incubator |
| topic | Degenerative cervical myelopathy Non-surgical Nonoperative Rehabilitation Multidisciplinary |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000943 |
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