What is the pathophysiology of DCM? What are the mechanisms of neurological injury and the molecular and anatomical consequences? [1]
The pathobiology of Degenerative Cervical Myelopathy (DCM) is poorly understood. A review published in 2020 found that only 47 pre-clinical studies had been performed [2]. Multiple anatomical structures and cell types (e.g. bones, discs, ligaments, blood vessels, neurons, microglia, astrocytes, oligodendrocytes) and processes (e.g. inflammatory, degenerative) are linked to the onset and progression of DCM. Unpicking this is critical to informing clinical care and also to developing new therapies. 
As part of AO Spine RECODE-DCM, a new framework was proposed to help inform research enquiry; that DCM is a function of mechanical stress, vulnerability and time [1]. 
Figure 2 

How Is Myelopathy.org and RECODE-DCM Working to Address this Priority?

We are delighted to be stimulating research into the biological basis of DCM through our Research Award, launched in 2022. The inaugural winner, Dr Michael G Fehlings, was awarded the 2022 prize for his work aligned with Research Priority 5. In Dr Fehlings’s publication “The influence of ApoE4 on the clinical outcomes and pathophysiology of degenerative cervical myelopathy“, his team in Toronto, Canada, explore the underlying mechanisms of neural degeneration and identify genetic factors that increase the risk of neurological decline in people with DCM. You can read more about this work in our blog post.

Learn More about Research Priority 5 on the Myelopathy Matters Podcast

In 2020, AO Spine took over the Myelopathy Matters podcast to tackle the Top 10 Research Priorities for DCM. Can pre-clinical research accelerate clinical trials in DCM and speed up finding solutions? This question is explored in Episode 5 of the AO Spine RECODE-DCM podcast series: Understanding the Biological Basis. Dr Benjamin Davies and Dr Michelle Starkey talk with Dr Mark Kotter, Prof James Fawcett, and Ellen Sarewitz, a healthcare communications expert living with DCM.
Listen to Podcast Episode: AO Spine Research Top 10 – No.5 – Biological Basis