Conservative Care Versus Decompression Trial for Degenerative Cervical Myelopathy Pilot

Patient-derived Modified Japanese Orthopaedic Association Scale (P-mJOA)

Patient reported outcome assessing (i) upper extremity sensation, (ii) upper extremity motor function, (iii) lower extremity motor function, and (iv) sphincter function. It is used to grade DCM severity, and scored between 0 and 18. Scores of 18 indicate no dysfunction, 15 to 17 indicate mild DCM, 12 to 14 indicate moderate DCM, 11 and lower indicating severe DCM.

Time frame: Baseline, 6 months, 12 months

Cervical Myelopathy Severity Index (CMSI)

The Cervical Myelopathy Severity Index (CSMI) assesses neurological function. It is a patient-completed 14-item measure for patients with DCM to evaluate symptom severity and functional limitations. Items span dexterity, balance/gait, pain, sensory impairment, and sphincter dysfunction. Each item is rated on a 4-point scale, from 0 (no difficulty), to 3 (severe difficulty). Total scores range from 0-42, with a higher score indicating higher DCM severity.

Time frame: Baseline, 6 months, 12 months

Neck Disability Index (NDI)

The NDI is a continuous measure ranging from 0 to 100 with higher scores indicating more severe disability.

Time frame: Baseline, 6 months, 12 months

Arm and Shoulder Pain

This will be measured using the 11-point Numerical Rating Scale (NRS), where 0 is 'no pain' and 10 is 'worst possible pain'.

Time frame: Baseline, 6 months, 12 months

Upper Extremity Neurologic Function

This will be measured using the grip-and-release test (G\&R test). Participants are asked to grip and release with the fingers as rapidly as possible with the forearm kept in pronation and the wrist in mild extension. The number of complete cycles of movement within 10 seconds are counted.

Time frame: Baseline, 6 months, 12 months

Lower Extremity Neurologic Function

This will be measured using the 30-m walking test (30MWT). Participants are asked to walk a straight 30-meter distance as quickly as possible with any normally used walking aids; number of steps and time is recorded.

Time frame: Baseline, 6 months, 12 months

Falls

Falls will be assessed using questions one and two of the modified American Geriatric/British Geriatric tool: "How many times have you fallen since the last visit?" and "Since the last visit, did you seek medical care for a fall injury?"

Time frame: Baseline, 6 months, 12 months

Dysphagia

Dysphagia will be assessed using the Bazaz Scoring System. This classifies patient reported swallowing difficulty into 4 categories: none, mild, moderate, severe.

Time frame: Baseline, 6 months, 12 months

Need for additional cervical spine surgery

This will be assessed and collected from patient self-report and medical records.

Time frame: Up to 12 months after the intervention.

Adverse Events

Occurrence of related adverse events will be monitored at every scheduled and unscheduled clinic visit.

Time frame: Through study completion, up to 12 months after intervention.