Tu Ji, Vargas Castillo Jose, Das Abhirup, Diwan Ashish D
Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia.
Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia.
J Clin Med. 2021 Mar 15;10(6):1214. doi: 10.3390/jcm10061214.
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
退行性颈椎脊髓病（DCM），早期称为颈椎病性脊髓病（CSM），是老年人群中最常见且最严重的神经系统疾病，由颈部脊髓的慢性渐进性压迫或刺激引起。DCM的临床特征包括局部颈部疼痛以及手臂、手指和手部运动功能的功能障碍。如果不进行治疗，这可能导致严重且永久性的神经损伤，包括瘫痪和死亡。尽管最近在理解DCM病理学方面取得了进展，但其预后仍然很差，对于其发病机制的分子机制知之甚少。此外，几乎没有证据表明哪种治疗方法最适合DCM患者。减压手术仍然是针对这种病理状况最有效的长期治疗方法，尽管决定何时进行此类手术仍然具有挑战性。鉴于世界老年人口持续增加，DCM正构成一项需要紧急关注的严峻挑战。在此全面综述中，我们讨论了DCM病理学的当前知识，包括流行病学、诊断、自然史、病理生理学、危险因素、分子特征和治疗选择。除了描述临床医生在诊断DCM时使用的不同评分和分类系统外，我们还强调了先进的成像技术如何用于研究疾病过程。最后但同样重要的是，我们讨论了DCM病因学的几个分子基础，包括涉及的细胞以及作为这种疾病标志的途径和分子。
