The Pathophysiology of Degenerative Cervical Myelopathy and the Physiology of Recovery Following Decompression

Farhana Akter; Xinming Yu; Xingping Qin; Shun Yao; Parisa Nikrouz; Yasir Ahmed Syed; Mark Kotter

doi:10.3389/fnins.2020.00138

The Pathophysiology of Degenerative Cervical Myelopathy and the Physiology of Recovery Following Decompression

Front Neurosci. 2020 Apr 30:14:138. doi: 10.3389/fnins.2020.00138. eCollection 2020.

Authors

Farhana Akter^{1

2

3}, Xinming Yu¹, Xingping Qin³, Shun Yao⁴, Parisa Nikrouz⁵, Yasir Ahmed Syed^{6

7}, Mark Kotter¹

Affiliations

¹ Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom.
² Faculty of Arts and Sciences, Harvard University, Cambridge, MA, United States.
³ Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States.
⁴ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
⁵ Maidstone and Tunbridge Wells Trust, Maidstone, United Kingdom.
⁶ Neuroscience and Mental Health Research Institute (NMHRI), Cathays, United Kingdom.
⁷ School of Bioscience, Cardiff University, The Sir Martin Evans Building, Cardiff, United Kingdom.

Abstract

Background: Degenerative cervical myelopathy (DCM), also known as cervical spondylotic myelopathy is the leading cause of spinal cord compression in adults. The mainstay of treatment is surgical decompression, which leads to partial recovery of symptoms, however, long term prognosis of the condition remains poor. Despite advances in treatment methods, the underlying pathobiology is not well-known. A better understanding of the disease is therefore required for the development of treatments to improve outcomes following surgery. Objective: To systematically evaluate the pathophysiology of DCM and the mechanism underlying recovery following decompression. Methods: A total of 13,808 published articles were identified in our systematic search of electronic databases (PUBMED, WEB OF SCIENCE). A total of 51 studies investigating the secondary injury mechanisms of DCM or physiology of recovery in animal models of disease underwent comprehensive review. Results: Forty-seven studies addressed the pathophysiology of DCM. Majority of the studies demonstrated evidence of neuronal loss following spinal cord compression. A number of studies provided further details of structural changes in neurons such as myelin damage and axon degeneration. The mechanisms of injury to cells included direct apoptosis and increased inflammation. Only four papers investigated the pathobiological changes that occur in spinal cords following decompression. One study demonstrated evidence of axonal plasticity following decompressive surgery. Another study demonstrated ischaemic-reperfusion injury following decompression, however this phenomenon was worse when decompression was delayed. Conclusions: In preclinical studies, the pathophysiology of DCM has been poorly studied and a number of questions remain unanswered. The physiological changes seen in the decompressed spinal cord has not been widely investigated and it is paramount that researchers investigate the decompressed spinal cord further to enable the development of therapeutic tools, to enhance recovery following surgery.

Keywords: apoptosis; degeneration; neuronal loss; pathogenesis; spine.

Publication types

Systematic Review