The early signs of degenerative cervical myelopathy (DCM) include increasing clumsiness of the hands, difficulty with fine motor skills, sensory disturbances, or slight changes in gait and balance. As these complaints develop gradually and the symptoms may be unspecific at first, the underlying condition is often not detected at an early stage. If the condition is not treated, it can progress and lead to permanent neurological dysfunctions. These could be significant limitations in walking ability, hand function, or autonomic bodily functions. In severe cases, tetraplegia may develop.
Research as the foundation for a new treatment concept
An interdisciplinary team from Balgrist University Hospital, composed of experts from the Spinal Cord Injury Center, radiology and spine surgery departments, has spent years developing new diagnostic approaches. Quantitative imaging of the spinal cord, advanced neurophysiological procedures and sensitive functional assessments in particular make it possible to identify subtle spinal cord damage and neurodegenerative changes before they result in significant functional impairments.
These approaches form the basis of a perspective article, which has now been published in the medical journal The Lancet Neurology ((LINK)). The article combines clinical experience and research, and the consolidated findings are based on prospective studies from Balgrist University Hospital and the work of international co-authors. They can be used to better assess which patients with mild DCM have an increased risk of neurological deterioration. PD Dr. med. Carl Zipser, Senior Consultant at the Spinal Cord Injury Center and lead author, said: “We need to change how we view DCM. It shouldn’t be actual evidence of neurological damage that determines the timing of the diagnosis, but rather the first clinical signs of the onset of spinal cord injury.”
The article translates these findings into a common clinical framework for action. This includes making doctors more aware of the early signs of DCM, improving the training of medical students and healthcare professionals, and better informing patients with mild cases of the condition about possible early symptoms. The aim is to identify the condition earlier, better evaluate an individual's risk of the disease progressing and initiate treatment in a timely manner if the risk is elevated.
“A multimodal assessment helps to identify DCM earlier, better assess the individual risk of neurological deterioration and improve the prognosis. It enables us to move from a reactive treatment of neurological impairments that have already arisen to early treatment and the prevention of further damage,” explained Prof. Dr. med. Patrick Freund, Head of the Spinal Cord Injury Center and corresponding author.
Early detection and targeted treatment
The approach described in the perspective article is already being used in clinical practice at the University Spine Center at Balgrist University Hospital. The interdisciplinary collaboration between the Spinal Cord Injury Center and the radiology and spine surgery departments enables a comprehensive evaluation of patients with mild cervical myelopathy, so that individual treatment options can be identified.
“The findings show the importance of quickly transferring new scientific methods into clinical care. Particularly in the case of a progressive disease such as DCM, assessing the condition earlier and more precisely can be crucial for patients,” explained Prof. Dr. med. Mazda Farshad, Medical Hospital Director and Head of the University Spine Center at Balgrist University Hospital.
Scientific research work in this area will continue. Starting in 2027, a new cohort study will examine innovative diagnostic methods, and a clinical trial will investigate how the outcomes of neurological treatment can be further improved for patients who may require surgery.
The Lancet Neurology: Degenerative cervical myelopathy: early detection and the potential for preventing disability
Contact for further information:
T +41 44 386 14 15 / kommunikation@balgrist.ch