This protocol covers patients with degenerative cervical myelopathy (DCM) who are classified as mild on the modified Japanese Orthopedic Association (mJOA) scale — a score of 15 to 17 — and who have clinical signs and symptoms of myelopathy confirmed by cervical MRI evidence of spinal cord compression.
Mild DCM is defined by an mJOA score of 15 to 17. Diagnosis requires both neurological signs and symptoms consistent with myelopathy and imaging — typically cervical MRI — demonstrating spinal cord compression.
For patients with mild DCM, the evidence supports either a surgical pathway or a supervised trial of structured rehabilitation. The complete protocol specifies how to choose between these options and what to monitor over time.
The primary objectives are halting disease progression with no neurological deterioration and achieving measurable improvement in neurological function as reflected by the mJOA score.
DOI: 10.1177/2192568217703088
Based on the mJOA score, mild myelopathy is defined as 15, moderate as 12 to 14, and severe as 11.
DCM is diagnosed when a patient presents with signs and symptoms consistent with myelopathy and image (usually magnetic resonance imaging [MRI]) evidence of spinal cord compression.
We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM.
If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.
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