Chauhan Rohil V, Demetriades Andreas K, Boerger Timothy F, Lantz Justin M, Treanor Caroline, Kalsi-Ryan Sukhvinder, Kumar Vishal, Wood Lianne, Plener Joshua, Wilson Nicky, Fortin Maryse, Ammendolia Carlo, Paus Annalena, Dhillon Rana S, Davies Benjamin, Fehlings Michael G, Anderson David B
Auckland 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.
Brain Spine. 2025 May 8;5:104275. doi: 10.1016/j.bas.2025.104275. eCollection 2025.
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.
What is the role of non-surgical clinicians in the assessment and management of people with DCM?
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.
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.
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.
关于退行性颈椎脊髓病（DCM）的证据常常聚焦于手术治疗，而忽视了非手术临床医生的作用。在患者就医过程中，他们的贡献在文献中仍未得到充分探讨。
非手术临床医生在DCM患者的评估和管理中扮演什么角色？
本叙述性综述综合了来自全面的MEDLINE搜索的知识以及由Myelopathy.org主办的RECODE-DCM围手术期康复孵化器专家工作组的集体专业知识。非手术临床医生参与的关键领域包括：1）早期识别与转诊，2）患者教育，3）疼痛管理，4）术前管理，以及5）术后康复。
DCM的及时诊断取决于首诊临床医生识别标志性症状。在缺乏标准化筛查标准的情况下，如改良日本骨科协会评分等工具可支持早期识别。非手术临床医生对轻度或非脊髓病性脊髓压迫患者进行教育，使其认识到DCM进展的迹象，确保及时进行手术咨询。这些临床医生在疼痛的生物心理社会管理中也发挥着多学科作用，采用药物和非药物策略来处理伤害性疼痛和神经性疼痛。虽然已知术后结果的预测因素，如疾病严重程度、步态功能障碍和吸烟等，但关于术前优化和预康复的证据仍然有限。新出现的研究强调了早期术后康复的益处，包括颈椎活动度和稳定练习，有助于改善术后12个月的结果。
非手术临床医生在DCM整个护理过程的管理中发挥着不可或缺的作用。多学科、以患者为中心的方法至关重要。术后康复前景广阔，但需要进行前瞻性试验以建立标准化和最佳临床实施策略。
