Degenerative cervical myelopathy: early detection and the potential for preventing disability

Degenerative cervical myelopathy (DCM), the most common non-traumatic spinal cord injury, is a prevalent, progressive, and highly disabling neurological disease, causing heterogeneous impairment ranging from sensory loss and impaired hand dexterity to gait, balance, and autonomic dysfunction. Disability often persists despite surgical decompression, and untreated disease can progress to irreversible neurological injury, including tetraplegia. Current clinical management is largely reactive, with diagnosis and intervention typically only after neurological deterioration has become clinically apparent and radiographic evidence of cervical myelopathy is established. Advances in multimodal diagnostics over the past 5 years are now enabling the detection of subtle spinal cord injury, biological disease activity, and subclinical neurodegeneration before overt clinical disability. Quantitative spinal cord MRI, advanced neurophysiological assessments, dynamic biomechanical metrics, and sensitive functional testing provide complementary tools for early detection, risk stratification, and prognostication. Together, these approaches are redefining DCM as a disease that should be managed proactively. Evidence supports decompressive surgery in patients with moderate-to-severe disease, whereas in milder disease or in spinal stenosis that might develop into DCM, the management of patients should be interdisciplinary, with active surveillance to detect early deterioration or decompressive surgery in selected cases. Improved prediction of disease trajectories and clearer evidence on long-term outcomes could enable selective earlier intervention and help to prevent neurological disability.