Gharooni Aref-Ali, Kwon Brian K, Fehlings Michael G, Boerger Timothy F, Rodrigues-Pinto Ricardo, Koljonen Paul Aarne, Kurpad Shekar N, Harrop James S, Aarabi Bizhan, Rahimi-Movaghar Vafa, Wilson Jefferson R, Davies Benjamin M, Kotter Mark R N, Guest James D
Neurosurgery Unit, Department of Clinical Neuroscience, 2152University of Cambridge, UK.
Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada.
Global Spine J. 2022 Feb;12(1_suppl):109S-121S. doi: 10.1177/21925682211052920.
STUDY DESIGN: Narrative review. OBJECTIVES: To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' METHODS: A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. RESULTS: Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. CONCLUSION: There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.
研究设计:叙述性综述。 目的:概述针对詹姆斯·林德联盟关于退行性颈椎病(DCM)优先事项设定伙伴关系问题的当代疗法:“能否确定包括干细胞、基因、药理学和神经保护疗法在内的新型疗法,以改善DCM患者的健康和福祉并减缓疾病进展?” 方法:进行文献综述,以概述DCM的病理生理学,并介绍在神经保护、神经再生和神经调节三大类中可能具有治疗价值的当代疗法。 结果:慢性脊髓压迫会导致缺血、神经炎症、脱髓鞘和神经元丧失。手术干预可能会阻止疾病进展并改善症状,不过大多数患者无法完全康复,导致终身残疾。神经保护剂可破坏有害的继发性损伤途径,一种药物利鲁唑已在DCM中进行了III期研究。虽然它在主要结局指标改良日本骨科协会量表上未显示出疗效,但在减轻疼痛方面显示出有希望的结果。再生方法尚处于早期阶段,一种药物异丁司特目前正在进行III期研究。神经调节方法旨在通过多种方式的电刺激来治疗性地改变脊髓兴奋状态。使用神经肌肉和脊髓电刺激的案例研究已显示出积极的治疗效果启。 结论:对DCM在神经保护、神经再生和神经调节这三大领域的干预措施研究有限。DCM的当代和新型疗法现已成为十大优先事项之一,虽然在这些领域对DCM的研究有限,但希望本综述能鼓励对这一优先事项的研究。
Acta Neurochir (Wien). 2023-5
EFORT Open Rev. 2025-6-2
J Clin Med. 2024-11-25
BMC Med Res Methodol. 2023-4-22
Nat Rev Rheumatol. 2021-3
IEEE Trans Neural Syst Rehabil Eng. 2021
Front Hum Neurosci. 2020-12-11
Neurology. 2021-1-26
Front Physiol. 2020-11-4
Stem Cells Int. 2020-11-5