RECODE-DCM: Global consensus reached on degenerative cervical myelopathy as single unifying term

Benjamin Davies

A global, multi-stakeholder consensus process involving those with lived experience has selected degenerative cervical myelopathy (DCM) as the single unifying term for a progressive spinal cord injury due to narrowing of the cervical spinal canal.

Published by Benjamin Davies (Cambridge, UK) et al in the Global Spine Journal, the results of the AO Spine RECODE-DCM modified Delphi study, resulted in the consensus of a consistent term and definition to support education and research initiatives. “This was selected using a structured and iterative methodology, which may serve as an exemplar for others in the future,” say the study authors.

According to the study authors, cervical myelopathy caused by degenerative changes to the spine is known by over 11 different names globally. This inconsistency “contributes to many clinical and research challenges, including a lack of awareness”, they add.

To determine the index term, a longlist of candidate terms and their rationale, was created using a literature review and interviews. This was shared with the community, to select their preferred terms (248 members [58%], including 149 [60%] surgeons, 45 [18%] other healthcare professionals and 54 [22%] people with DCM or their supporters) and finalised using a consensus meeting.

To determine a definition, a medical definition framework was created using inductive thematic analysis of selected International Classification of Disease definitions. Separately, stakeholders submitted their suggested definition which also underwent inductive thematic analysis (317 members [76%], 190 [59%] surgeons, 62 [20%] other healthcare professionals and 72 [23%] persons living with DCM or their supporters). Using this definition framework, a working definition was created based on submitted content, and finalised using consensus meetings.

As a result, DCM was selected as the unifying term, defined in short, as a progressive spinal cord injury caused by narrowing of the cervical spinal canal.

Speaking to Spinal News International, Davies said: “I think it is easy to overlook the significance of this issue. Against the complexity of surgery for example, the choice of terminology can seem so secondary. But, ultimately speaking, a common language is fundamental to working together on research, clinical practice, patient education and raising awareness.

“DCM was not everyone’s first choice, but I hope the community can now recognise the need for unity, trust this structured and global process, and adopt it. This process has made a recommendation, but this problem is only solved if the community takes it forward. “


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