This protocol addresses patients with degenerative cervical myelopathy (DCM) at mild severity — mJOA score 15 to 17 — with signs and symptoms of cervical myelopathy and MRI evidence of spinal cord compression, whose initial management has not achieved neurological stabilisation or improvement.
Mild DCM is diagnosed when a patient presents with signs and symptoms consistent with myelopathy and MRI evidence of cervical spinal cord compression, with an mJOA score of 15 to 17. At this severity, initial management may include either a surgical approach or a supervised trial of structured rehabilitation.
When a supervised trial of structured rehabilitation was pursued and the patient failed to halt disease progression, developed neurological deterioration, or showed no improvement in neurological function on the mJOA score, escalation to the next management step is warranted.
Following failure of nonoperative management, the indicated direction involves operative intervention targeting decompression of the cervical spinal cord — though the specific approach, indications, and full decision pathway are detailed only in the complete protocol.
Specific technique, timing, and complete decision criteria are available in the full structured protocol below.
A successful outcome is defined as a final postoperative mJOA score of 16 or higher, reflecting meaningful neurological recovery.
DOI: 10.1177/2192568217703088