STUDY DESIGN: Narrative review. OBJECTIVES: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). METHODS: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. RESULTS: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. CONCLUSION: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

Department of Neurological Surgery Thomas Jefferson University Philadelphia PA USA

Department of Neurology University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Neurosciences University of Cambridge Cambridge United Kingdom

Department of Neurosurgery and The Miami Project to Cure Paralysis The Miller School of Medicine University of Miami FL USA

Department of Neurosurgery Charité Universitätsmedizin Berlin Germany

Department of Neurosurgery Medical College of Wisconsin Wauwatosa WI USA

Department of Neurosurgery Sina Trauma and Surgery Research Center Tehran University of Medical Sciences Tehran Iran

Department of Neurosurgery University of California Davis Sacramento CA USA

Department of Neurosurgery University of Cincinnati Cincinnati OH USA

Department of Neurosurgery University of Maryland Baltimore MD USA

Department of Orthopedic Surgery Nagoya University Graduate School of Medicine Nagoya Japan

Department of Orthopedic Surgery Wakayama Medical University Wakayama Japan

Division of Neurosurgery and Spine Program University of Toronto Ontario Canada

Division of Neurosurgery Geneva University Hospitals University of Geneva Geneva Switzerland

Myelopathy org International Charity for Degenerative Cervical Myelopathy United Kingdom

Vancouver Spine Surgery Institute Department of Orthopedics The University of British Columbia Vancouver British Columbia Canada

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Evidence-based commentary on the diagnosis, management, and further research of degenerative cervical spinal cord compression in the absence of clinical symptoms of myelopathy