10. INDIVIDUALISING SURGERY
Are there clinical and imaging factors that can help a surgeon select who should undergo surgical decompression in the setting of DCM? At what stage of the disease is surgery the preferred management strategy? 
A range of different surgical techniques can be used to treat Degenerative Cervical Myelopathy (DCM), each with differing proposed benefits and some risks. So far, high-quality, comparative and prospective observational studies have not identified clear advantages of one technique over another. Instead, recognising the wide variety of degenerative pathologies that can affect the spinal cord, it is more likely that different techniques will benefit different subgroups of DCM. Advancing this evidence base is critical, to ensure that the outcomes from surgery (today’s only disease-modifying therapy) are as good as possible.
We hear from surgeon Dr James Harrop on why it is so important to consider your patient’s priorities before making surgical decisions.
How Is Myelopathy.org and RECODE-DCM Working to Address this Priority?
In July 2021, funding commenced on a study led by Dr Mark Kotter and Dr Benjamin Davies to determine the optimal surgical management for certain cases of DCM. Surgery on the spine may be performed either from the front (anterior) or from the back (posterior). In the UK, there are two main posterior options: laminectomy alone; and laminectomy and fusion. The choice of surgical procedure, rather than being evidence-based, is currently left to the discretion of the treating surgeon. This leads to variation in practice, with implications for both the patients and the healthcare providers.
The POLYFIX-DCM trial will establish the optimal surgical management, following patients’ functional outcome over 2 years following surgery, as well as other critical measures such as pain, quality of life, and cost-effectiveness.
For further details, please visit the POLYFIX-DCM study website.
Shared decision making refers to a process in which a healthcare professional works with a patient to come to a care decision. This contrasts with the model of care in which a healthcare professional simply makes their recommendation to the patient. Shared decision making is recognized as particularly valuable under circumstances in which the decision is not clear cut, for example “What type of surgery should be performed?”
With an award from the Evelyn Trust, Myelopathy.org is laying the foundations for shared decision making in DCM: first, we are creating a core information set to ensure that patients are sufficiently knowledgeable to enter into treatment discussions; and second, we are mapping out all of the decisions they may encounter. The ambition is that tools to support shared decision making at specific decision points can be created as living documents, to be updated as evidence improves. Find out more about SHARED-DCM.
Myelopathy.org is working with researchers at the University of Melbourne to create a patient decision aid for one known and critical decision point, “Should I have surgery?”.
Learn More about Research Priority 10 on the Myelopathy Matters Podcast
In 2020, AO Spine took over the Myelopathy Matters podcast to tackle the Top 10 Research Priorities for DCM. This episode focuses on Individualising Surgery in the setting of DCM. Are there clinical and imaging factors that can help select who should undergo surgical decompression? At what stage of the disease is surgery the preferred management strategy? Dr Benjamin Davies and Dr Michelle Starkey put the questions to Daniel Simpson, Dr James Harrop, and Dr Lindsay Tetreault.
Listen to Podcast Episode: AO Spine Research Top 10 – No. 10 – Individualising Surgery
For further coverage of Daniel Simpson’s successful surgery carried out by Dr James Harrop, please listen to S3E8 of Myelopathy Matters.