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Degenerative Cervical Myelopathy
From Basic Science to Clinical Practice
- 1st Edition - November 23, 2023
- Editor: Michael G. Fehlings
- Language: English
- Hardback ISBN:9 7 8 - 0 - 3 2 3 - 9 5 3 3 4 - 4
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 9 5 7 9 1 - 5
Degenerative Cervical Myelopathy: From Basic Science to Clinical Practice lays the foundation for understanding DCM manifestation, pathophysiology, diagnosis and treatment… Read more
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Request a sales quoteDegenerative Cervical Myelopathy: From Basic Science to Clinical Practice lays the foundation for understanding DCM manifestation, pathophysiology, diagnosis and treatment strategies. The book covers the latest basic and clinical research, updates on patient management strategies, and discusses promising neuroprotective therapies for the future of DCM care. Written by international experts across a range of topics related to degenerative cervical myelopathy, the book helps readers understand the challenges and future directions of patient management.
As degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction and one of the most common indications for spinal surgery worldwide, the term DCM encompasses a group of chronic, non-traumatic spinal cord injuries that occur due to degenerative changes in the cervical spine (e.g. disc spondylosis or repetitive dynamic injury from hyper-mobility).
- Covers recent clinical trial advancements and the impact of trial findings
- Presents recent clinical guidelines for the management of degenerative cervical myelopathy, providing readers with insights regarding the translation of research from bench to bedside
- Provides readers with the skills needed to understand the translational pathway using real-life examples
Orthopaedic Surgeons, Neurosurgeons, Clinical Spine Fellows, Residents, Clinical and Basic Researchers, Public Health Organizations, Ergonomists, Medical Students, Rehabilitation Specialists, Neurologists, Physiatrists, Physiotherapists, Chiropractors, Family Physicians, General Internists, reference for anyone interested in better understanding degenerative changes to the cervical spine, undergraduate and graduate level neuroscience, molecular biology, anatomy, genetics, and motor behavior students with an interest in nervous system injury, members of industry and policy makers who are looking to better understand degenerative cervical myelopathy management practices
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- List of contributors
- Foreword
- Preface
- Chapter 1. Degenerative cervical myelopathy: an overview of the commonest form of spinal cord impairment in adults
- Abstract
- Introduction
- Diagnosis of degenerative cervical myelopathy
- Treatment of degenerative cervical myelopathy
- Overview of chapters
- Anatomy and physiology of the cervical spine and the cervical spinal cord
- Epidemiology, genetics, and classification of degenerative cervical myelopathy
- Pathophysiology of degenerative cervical myelopathy
- Clinical assessment tools
- Imaging for degenerative cervical myelopathy
- Neurophysiology and advanced dynamic assessments in degenerative cervical myelopathy
- Assessment of cervical alignment and deformity
- Natural history and patient trajectory in degenerative cervical myelopathy
- Role of the primary care practitioner in the assessment and management of degenerative cervical myelopathy
- Research objectives and common data elements for degenerative cervical myelopathy: from research priorities to global action
- Overview of management options for degenerative cervical myelopathy
- Defining the position of rehabilitation in the management of degenerative cervical myelopathy
- Decision-making in surgical management of degenerative cervical myelopathy
- Anterior surgical approaches to treat degenerative cervical myelopathy
- Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminectomy±fusion
- Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminoplasty
- Nonoperative management of degenerative cervical myelopathy
- Neuroregenerative strategies for degenerative cervical myelopathy
- State of the art and future directions of degenerative cervical myelopathy
- References
- Chapter 2. Anatomy and physiology of cervical spine and cervical spinal cord
- Abstract
- Introduction
- Osseous anatomy
- Subaxial cervical spine
- Cervicothoracic junction
- Articulation
- Ligaments
- Fascia
- Muscular anatomy
- Vascular supply
- Venous system
- Neural tissue
- Functional anatomy and physiology of the cervical spine
- Functional anatomy of the gray matter of the spinal cord
- Functional anatomy of the white matter of the spinal cord
- Circuits of the spinal cord
- References
- Chapter 3. Classification, epidemiology, and genetics of degenerative cervical myelopathy
- Abstract
- Introduction
- Classification: the disease spectrum of degenerative cervical myelopathy
- Epidemiology
- Genetics
- Conclusion
- References
- Chapter 4. Pathophysiology of degenerative cervical myelopathy
- Abstract
- Introduction
- Spinal compression and mechanical injury
- Genetic risk factors
- Ischemia and blood–spinal cord barrier disruption
- Ischemia–reperfusion injury
- Neuroinflammation
- Systemic implications
- Animal models of degenerative cervical myelopathy
- References
- Chapter 5. Clinical assessment tools
- Abstract
- Introduction
- What are we trying to measure in degenerative cervical myelopathy?
- Considerations for a clinical assessment
- Current assessments used in DCM and their evidence base
- Emerging assessments
- Conclusions
- References
- Chapter 6. Conventional and advanced magnetic resonance imaging for degenerative cervical myelopathy
- Abstract
- Introduction
- Computed tomography and radiographs of the spine
- Conventional magnetic resonance imaging of spinal cord
- Quantitative magnetic resonance imaging and its benefits in spinal cord
- Functional magnetic resonance imaging of the spinal cord
- Conclusion
- References
- Chapter 7. Neurophysiology and advanced dynamic assessments in degenerative cervical myelopathy
- Abstract
- Introduction
- Advanced neurophysiological measures of spinal cord impairment
- Spinal cord motion: a measure of cord stress
- Cerebrospinal fluid pressure dynamics
- Conclusion and future directions
- References
- Chapter 8. Assessment of cervical alignment and deformity
- Abstract
- Introduction
- Anatomy
- Clinical assessment
- Radiological assessment
- Computed tomography
- Magnetic resonance imaging
- Specific considerations for the cranio-cervical junction
- Specific considerations for the subaxial spine
- Specific considerations for the cervicothoracic junction
- Patient-reported outcomes
- Conclusion
- References
- Chapter 9. Natural history and patient trajectory in degenerative cervical myelopathy
- Abstract
- Introduction
- Natural history of the cervical degenerative process
- Natural history of nonmyelopathic spinal cord compression
- Risk factors for the development of degenerative cervical myelopathy
- Progression of DCM in conservatively managed patients
- Postoperative course of DCM and patient reported outcomes
- Summary and future directions
- References
- Chapter 10. Role of the primary care practitioner in assessment and management of degenerative cervical myelopathy
- Abstract
- Importance of primary care
- Primary care and degenerative cervical myelopathy
- Barriers to diagnosing degenerative cervical myelopathy in primary care
- Diagnosis of degenerative cervical myelopathy in primary care
- Management of degenerative cervical myelopathy in primary care
- Improving the current state
- Conclusion
- Acknowledgments
- References
- Chapter 11. RECODE-DCM: from research priorities to global action
- Abstract
- Introduction
- Establishing the top 10 research priorities
- Addressing other areas of inefficiency
- Further insights from RECODE-DCM: the “diversity bonus”
- Future opportunities for RECODE-DCM
- Conclusion
- Acknowledgments
- References
- Chapter 12. Overview of management options for degenerative cervical myelopathy
- Abstract
- Introduction
- Epidemiology of degenerative cervical myelopathy
- Pathophysiology of degenerative cervical myelopathy
- Natural history of degenerative cervical myelopathy
- Diagnosis of degenerative cervical myelopathy
- Signs and symptoms of degenerative cervical myelopathy
- Outcome measures of interventions for degenerative cervical myelopathy
- Radiography and degenerative cervical myelopathy
- Electrophysiological assessment of degenerative cervical myelopathy
- A differential diagnosis for degenerative cervical myelopathy
- Current guidelines for management of degenerative cervical myelopathy
- Operative management of degenerative cervical myelopathy
- Nonoperative management of degenerative cervical myelopathy
- Conclusion
- References
- Chapter 13. Defining the position of rehabilitation in the management of degenerative cervical myelopathy
- Abstract
- Introduction and overview
- Degenerative cervical myelopathy severity and management
- A practical rehabilitation approach to clinical assessment of the patient with degenerative cervical myelopathy
- Practical rehabilitation management principles
- Standardized assessment tools for rehabilitation in degenerative cervical myelopathy
- The current state of evidence for rehabilitation after degenerative cervical myelopathy
- References
- Chapter 14. Decision-making in the surgical management of degenerative cervical myelopathy
- Abstract
- Introduction
- Summary
- References
- Chapter 15. Anterior surgical approaches to treat degenerative cervical myelopathy
- Abstract
- Abbreviations
- Introduction
- Anatomic essentials for anterior cervical discectomy and fusion
- Superficial landmarks
- Musculature of the anterior neck
- Vasculature of the anterior neck
- Nervous system structures of the anterior neck
- Visceral structures of the anterior neck
- Indications and contraindications for anterior cervical spine surgery
- Relative contraindications
- Anterior cervical spine surgical approach
- Dissection
- Discectomy
- Corpectomy
- Cervical disk arthroplasty
- Grafts and devices used for anterior cervical discectomy and anterior column reconstruction after cervical corpectomy
- Bone autograft and allograft
- Titanium and polyetheretherketone stand-alone cages
- Titanium mesh cages
- Expandable cages
- Polymethylmethacrylate reconstruction
- Instrumented fusion: to plate or not to plate?
- Complications associated with a ventral approach
- Esophageal perforation
- Recurrent laryngeal nerve palsy
- C5 palsy
- Cerebrospinal fluid leak
- Vertebral artery injury
- Horner’s syndrome
- Hardware failure and pseudarthrosis
- Infection
- Postoperative soft tissue and epidural hematomas
- Worsening myelopathy or radiculopathy
- Postoperative management
- Authors’ concluding remarks
- References
- Chapter 16. Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminectomy +/− fusion
- Abstract
- Introduction
- Pitfalls in cervical laminectomy and fusion surgery
- References
- Chapter 17. Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminoplasty
- Abstract
- Summary of key points
- Background of the development of laminoplasty
- Surgical indications
- Pearls and pitfalls for the actual surgery of laminoplasty
- Surgical outcomes
- Predictors that affect surgical outcomes
- Comparative results between the open-door and double-door laminoplasties
- Complications
- Comparative results between the laminoplasty and other approaches
- Conclusions
- References
- Chapter 18. Nonoperative management of degenerative cervical myelopathy
- Abstract
- Introduction
- Principles and recommendations for spinal cord rehabilitation
- Modalities of nonoperative management of degenerative cervical myelopathy
- Potential neuroprotective strategies
- Management of secondary health conditions
- Final considerations
- References
- Chapter 19. Emerging potential neuroregenerative strategies for degenerative cervical myelopathy
- Abstract
- Regenerative strategies are appropriate given the severity of injury in degenerative cervical myelopathy
- Modulating the extracellular environment to increase plasticity and regeneration
- Targeting cell-intrinsic regenerative capabilities
- Cell replacement and ex vivo gene therapy with neurotrophic factors
- Conclusions and future directions
- References
- Chapter 20. State of the art and future directions of degenerative cervical myelopathy
- Abstract
- Introduction
- The evolution of the term “degenerative cervical myelopathy”
- New insights in the pathophysiology and risk factors of degenerative cervical myelopathy
- Current population trends and epidemiology
- Advances in diagnostic imaging: looking for evidence of spinal cord distress
- Serum biomarkers and the promise of personalized degenerative cervical myelopathy therapy
- Therapeutic strategies: current and emerging themes
- Summary
- References
- Index
- No. of pages: 378
- Language: English
- Edition: 1
- Published: November 23, 2023
- Imprint: Academic Press
- Hardback ISBN: 9780323953344
- eBook ISBN: 9780323957915
MF
Michael G. Fehlings
Dr. Fehlings is the Vice Chair Research for the Department of Surgery at the University of Toronto and Head of the Spinal Program at Toronto Western Hospital, University Health Network. Dr. Fehlings is a Professor of Neurosurgery at the University of Toronto, holds the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration, is a Scientist at the McEwen Centre for Regenerative Medicine and a McLaughlin Scholar in Molecular Medicine. In the fall of 2008, Dr. Fehlings was appointed the inaugural Director of the University of Toronto Neuroscience Program (which he held until June 2012) and is currently Co-Director of the University of Toronto Spine Program. Dr. Fehlings combines an active clinical practice in complex spinal surgery with a translationally oriented research program focused on discovering novel treatments to improve functional outcomes following spinal cord injury (SCI).
Affiliations and expertise
Professor, Vice Chair Research, Department of Surgery, Halbert Chair in Neural Repair and Regeneration, Co-Chairman Spinal Program, University of Toronto; Head Spinal Program, McEwen Centre for Regenerative Medicine, Toronto Western Hospital