PERFORM Publications

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
Authors:	Chauhan RV , Demetriades AK , Boerger TF , Lantz JM , Treanor C , Kalsi-Ryan S , Kumar V , Wood L , Plener J , Wilson N , Fortin M , Ammendolia C , Paus A , Dhillon RS , Davies B , Fehlings MG , Anderson DB ,
Link:	https://pubmed.ncbi.nlm.nih.gov/40487873/
DOI:	10.1016/j.bas.2025.104275
Category:
PMID:	40487873
Dept Affiliation:	SOH 1 Auckland Spine Surgery Centre, Auckland, New Zealand. 2 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. 3 Department of Neurosurgery, University Neurosurgical Center Holland, UMC \| HMC \| HAGA, Leiden, The Hague, the Netherlands. 4 Department of Neurosurgery, Royal Infirmary, Edinburgh, UK. 5 Medical College of Wisconsin, Milwaukee, USA. 6 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA. 7 Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 8 National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland. 9 School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland. 10 KITE Research Institute, University Health Network, Toronto, Canada. 11 Postgraduate Institute of Medical Education and Research, Chandigarh, India. 12 Department of Public Health and Sports Science, University of Exeter, Exeter, EX1 2LU, UK. 13 Department of Medicine, Mount Sinai Hospital, Toronto, Canada. 14 Physiotherapy Department, King's College Hospital NHS Foundation Trust, UK. 15 London, UK & Centre for Rheumatic Disease, King's College London, London, UK. 16 Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, Qc, Canada. 17 Department of Surgery, University of Toronto, Toronto, Canada. 18 Department of Therapeutic Health Professions, University Hospital Münster, Germany. 19 Department of Surgery, University of Melbourne, Victoria, Australia. 20 Department of Neurosurgery, St Vincents Hospital Melbourne, Victoria, Australia. 21 Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. 22 Myelopathy.org, Cambridge, UK. 23 Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Canada. 24 Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 25 Sydney Spine Institute, Burwood, Sydney, Australia.

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.

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