Browsing by Author "Tessitore, Enrico"
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Publication A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence Synthesis to Inform an AO Spine Expert Opinion Statement(2025) Agrawal, Vinisha; Farhan Ali, Mohammed; Yasin, Froher; Ashraf, Daniyal; Brannigan, Jamie F. M.; Yurac, Ratko; Kumar, Vishal; Murphy, Rory; Tessitore, Enrico; Molliqaj, Granit; Dejaegher, Joost; Zamorano, Juan José; Wynne-Jones, Guy; Tripathi, Manjul; Anderson, David B.; Arbatin, Jose Joefrey F.; Kato, So; Romelean Jayapalan, Ronie; Dea, Nicolas; Harrop, James S.; Wilson, Jefferson; Kwon, Brian K.; Martin, Allan R.; Bednarik, Josef; Kotter, Mark R.; Davies, Benjamin M.; Mowforth, Oliver D.; Nouri. AriaStudy Design: Systematic review. Objectives: The pre-symptomatic state of Degenerative Cervical Myelopathy (DCM), wherein degenerative changes and spinal cord compression are seen without clinical findings, is poorly understood and inconsistently categorised. Clear identification may elucidate the temporality of DCM development. Therefore, a systematic assessment was undertaken of current terminology for pre-DCM states, with the objective of standardising definitions and informing an AO Spine expert position statement. Methods: Medline and Embase were searched for all studies on asymptomatic spinal compression or clinical findings preceding DCM, returning 3585 studies. After screening, 96 studies were included in the final analysis. The terminology used for pre-DCM states and their definitions were extracted, along with their frequencies or speciality/country of author in the literature. Results: Multiple terms were used to represent pre-DCM stages, including “asymptomatic” (86 studies), “non-myelopathic” (26 studies), “without myelopathy” (15 studies), “pre-symptomatic” (9 studies) and “sub-clinical” (7 studies). “asymptomatic” was associated with the greatest inconsistency. Some defined this as patients with radiological signs of spinal degeneration with/without spinal cord compression but no clinical signs of myelopathy, whereas others used the term synonymously with healthy controls. This inconsistency is particularly challenging in clinical studies in which DCM patients are compared to those with pre- DCM states and/or healthy volunteers. Conclusion: There is substantial inconsistency in the terms used to describe pre-DCM states. There is no clear relationship between the terms used and the country or speciality of the main author. Standardised definitions for these disease states should be agreed and used in future studies.Publication Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey(2024) Brannigan, Jamie; Davie, Benjamin; Mowforth, Oliver; Yurac, Ratko; Kumar, Vishal; Dejaeghe, Joost; Zamorano, Juan; Murphy, Rory; Tripath, Manjul; Anderson, David; Harrop, James; Molliqaj, Granit; Wynne-Jones, Guy; Joefrey, Jose; Kato, So; Ito, Manabu; Wilson, Jefferson; Romelean, Ronie; Dea, Nicolas; Graves, Daniel; Tessitore, Enrico; Martin, Allan; Nouri, AriaObjective: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. Methods: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. Results: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. Conclusions: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.