Table 1.
Top 26 priorities for DCM research. Priorities are listed in descending order of established importance. Each priority has a unique single-letter ID, a ‘key phrase’ and a set of associated questions
| Priority # | Question | Key phrase |
|---|---|---|
| 1 | What strategies can increase awareness and understanding of DCM amongst healthcare professionals and the public? Can these strategies help improve timely diagnosis and management of DCM? | Raising awareness |
| 2 | What is the natural history of DCM? What is the relationship between DCM and asymptomatic spinal cord compression or canal stenosis? What factors influence the natural history of the disease? | Natural history |
| 3 | What are the diagnostic criteria of DCM? When should imaging be used in the assessment of DCM? | Diagnostic criteria |
| 4 | How can the severity of DCM be evaluated? What assessment tools can be used to evaluate functional impairment, disability and quality of life in people with DCM? What instruments, tools or methods can be used or developed to monitor people with DCM for disease progression or improvement either before or after surgical treatment? Is there a role for smart technology? | Assessment and monitoring |
| 5 | What is the pathophysiology of DCM? What are the mechanisms of neurological injury and the molecular and anatomical consequences? | Pathophysiology |
| 6 | What is the role of non-operative or peri-operative management or rehabilitation for DCM? What are the most effective strategies? | Rehabilitation |
| 7 | Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, improve the health and wellbeing of people living with DCM and slow down disease progression? | Novel therapies |
| 8 | What is the socio-economic impact of DCM (the financial impact of living with DCM to the individual, their supporters and society as a whole)? | Socio-economic impact |
| 9 | What is the role of dynamic imaging and novel, unconventional or advanced techniques in the assessment of DCM? | Imaging techniques |
| 10 | Are there clinical and imaging factors that can help a surgeon select who should undergo surgical decompression in the setting of DCM? At what stage of the disease is surgery the preferred management strategy? | Individualising/staging of surgery |
| 11 | What are the main signs and symptoms that people with DCM present with? What are the frequency, sensitivity, specificity and positive predictive value of symptoms and signs (clinical assessments) for DCM? | Signs and symptoms |
| 12 | What is the optimal follow-up for people with DCM managed conservatively and surgically? What is the appropriate follow-up for people with DCM or those with spinal cord compression but no myelopathy? Who should follow these individuals? How often should new imaging be obtained? How should changes in neurological status be documented or addressed? | Follow-up |
| 13 | What are the most effective therapies for treatment of specific symptoms of DCM and the prevention of associated complications in DCM, including spasticity, imbalance and sensory, bladder or bowel dysfunction? | Symptom management |
| 14 | What are the factors that predict the development of myelopathy in people with evidence of spinal cord compression and no symptoms? | Predictors of development |
| 15 | What are the most important determinants of functional outcomes, quality of life and patient satisfaction following surgical or non-operative treatment for DCM? | Predictors of outcome, QoL, and satisfaction |
| 16 | What clinical and/or imaging features are predictive of neurological deterioration in people with DCM? Are there certain features that indicate irreversible disease? | Predictors of progression |
| 17 | What are the risk factors for the development or progression of DCM, including but not limited to lifestyle, diet, exercise, posture, occupation, history of trauma and coexistent disease? Does their modification have a role in prevention or treatment? | Risk factors for development/progression |
| 18 | What is the ideal timing for surgical intervention? | Timing of surgery |
| 19 | What is the efficacy and safety of non-operative treatment in the management of DCM compared with surgical treatment? Can non-operative treatment avoid the need for surgery long-term? When can a ‘watch and wait’ approach be adopted? | Non-operative treatment |
| 20 | What are the most effective therapies for treating pain in people with DCM? | Pain management |
| 21 | What is the preferred management strategy for people with mild DCM? What is the most cost-effective management strategy in this cohort? Are there clinical and imaging features that predict who should undergo surgical decompression and/or when? | Management of mild DCM |
| 22 | Can cerebrospinal fluid (CSF) or serum biomarkers be identified to support early diagnosis of DCM, and/or predict treatment outcomes? | Biomarkers |
| 23 | What lifestyle modifications (such as physical activity or exercise) are required or should be recommended to people with DCM to support recovery, avoid deterioration and improve quality of life? | Lifestyle modifications |
| 24 | What is the role of surgery in the management of people with imaging evidence of cord compression but no specific features of myelopathy? Is this decision impacted by signal change on T2-weighted MRI images or the presence of neck pain? | Surgery for pre-myelopathic compression |
| 25 | What treatments should be implemented following surgery and continued in the long-term? Is there a role for extended rehabilitation and exercise programmes? What should be its frequency, content and duration, and whom should it be coordinated by? | Post-operative treatment |
| 26 | What is the incidence of adjacent segment degeneration following surgery for DCM? Are there strategies that can reduce the incidence of adjacent segment degeneration? | Adjacent segment degeneration |