학술논문
A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time
Document Type
article
Author
Davies, Benjamin M; Mowforth, Oliver; Gharooni, Aref-Ali; Tetreault, Lindsay; Nouri, Aria; Dhillon, Rana S; Bednarik, Josef; Martin, Allan R; Young, Adam; Takahashi, Hitoshi; Boerger, Timothy F; Newcombe, Virginia FJ; Zipser, Carl Moritz; Freund, Patrick; Koljonen, Paul Aarne; Rodrigues-Pinto, Ricardo; Rahimi-Movaghar, Vafa; Wilson, Jefferson R; Kurpad, Shekar N; Fehlings, Michael G; Kwon, Brian K; Harrop, James S; Guest, James D; Curt, Armin; Kotter, Mark RN
Source
Global Spine Journal. 12(1_suppl)
Subject
Language
Abstract
Study designLiterature Review (Narrative).ObjectiveTo propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5.MethodsDegenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework.ResultsPresent pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time.ConclusionUnderstanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.