Diagnostic criteria

What are the diagnostic criteria of DCM? What is the role of imaging and when should imaging be used in the assessment of DCM? 

Podcast Episode 3: Diagnostic criteria

What are the Diagnostic Criteria for DCM, what is the role of imaging, when should it be used? In Episode 3 of AO Spine RECODE-DCM podcast, Ben Davies and Michelle Starkey talk with Iwan Sadler, James Harrop, and Brian Kwon.

Current evidence and reason for uncertainties

No formal diagnostic criteria published for DCM.

No systematic reviews, scoping reviews or guidelines identified.

Source of uncertainty

  • Spinal surgeons


  • Other healthcare professionals


  • People with DCM and their supporters


  • Original suggestions*

    * This list shows the original survey submission(s) that informed the indicative uncertainties and the resulting priority question.

    What are the practical versus theoretical definitions of DCM?

    Other findings clinical,  lab and radiological. Where access to early MRI is not feasible

    What does it mean? Myelopathy? 

    What does myelopathy mean ?

    What are the proper imaging exams required to get an exhaustive DCM diagnosis? Is the MRI sufficient?

    What are the absolute signs and symptoms to diagnose DCM and what is the Internationally accepted diagnostic criteria

    What tools, besides MRI are available, that can help confirm a diagnosis of DCM and help exclude differential diagnoses.

    What standard protocols do or should exist and by which specialists?

    What tests are really necessary for the diagnosis of DCM?

    How can we diagnosis?

    Are there other ways of diagnosing /or investigating myelopathy other than MRI?

    Why is it that it takes a MRI to diagnose cervical myelopathy?   I had symptoms way before the doctors figured out what I have.

    Most important radiological findings

    Not sure if the 'degenerative,' aspect has been made clear to me thus far.

    Better MRI and CT grading of DCM

    A qualitative study (potentially focus group design) on patient experiences on the journey to diagnosis (with a view to streamlining services and access to timely assessment and imaging)

    What MRI changes signify symptomatic DCM rather than asymptomatic degenerative change?

    We don't really have good, standard definition of DCM and there can be  a lot of variability in diagnosis. What can we do to improve this? 

    Is MRI a must before starting the treatment?

    Do MRI at 1.5 Tesla scanner work adequately for the diagnosis of DCM


    The understanding of DCM as chronic or subacute SCI and to use a common grading system for all SCI entities  A robust and easy diagnostic criteria of subclinical DCM   A diagnostic criteria and algorithm consisting of neurology and functional state with treatment recommendations

    Soft signs of degenerative myelopathy?

    Does the presence of hyperintensity signal in the spinal cord mean DCM? Is there a minimum pattern of clinical signs that define DCM?

    How to diagnose the cause? History taking alone?

    Could any microstructural, functional or biochemical abnormalities detected with MRI (such as diffusion MRI, fMRI, MR spectroscopy) or electrophysiological tests (evoked potentials) be used as markers of DCM in addition to MR signs of cervical cord compression an clinical symptoms and/or signs?

    Are there reliable surrogate markers in order to diagnose DCM?  

    If there is no canal stenosis is there a diagnostic tool that can diagnose DCM with certainty as change in spinal cord signal (called myelomalacia) is too late?

    What are the evidence-informed clinical tests for the diagnosis of DCM?

    Is there a standard protocol for radiologists to read and report on DCM?  

    What are the typical presentations?

    Does the presence of high signal on MRI mean that we are too late in treating effectively?  2. Can we diagnose clinically before high signal on MRI?

    Can an objective method be developed to diagnose DCM, such as electrophysiology, blood biomarker or MRI diagnostic test?

    What other criteria one should look at ? Are there any other clinical signs other than described in the clinical evaluation ?

    Why is it that it takes a MRI to diagnose cervical myelopathy?   I had symptoms way before the doctors figured out what I have.

    How important is spinal cord signal change in defining DCM?  Which are the most important neurological findings in defining DCM?  How important are spinal canal measurements? 

    What type of patient should we consider taking MRI?

    MRI criteria of DCM. MR changes of the spine and/or spinal cord which is predictable for DCM?

    I had to see many doctors and each had different thoughts.    finally saw a neurologist who told me it was DCM but even then there was uncertainty about how to proceed.  so I guess I would like more clear guidelines about how to diagnose

    What should be the main diagnostic tool for DCM detection - clinical findings, evoked potentials, MRI?

    In the need of a good diagnosis-treatment algorythm in DCM we do need a prognostic classification system. Can we classify DCM like we do in Lumbar Spinal Stenosis by the Schizas system ?

    What are the common presenting symptoms for DCM? What role do upper / lower limb changes (sensory, motor, DTR/ UMN findings play in this diagnosis? When is cross sectional imaging relevant?

    Are there any gold-standard manual tests (non-neurological assessment) for effective diagnosis of DCM?

    Proportion of patients with typical spinal cord symptoms such as hyperreflexia, and age-related differences

    Clinical and imaging criteria

    What is at the moment the gold standard for the diagnosis of DCM?

    What is the most appropriate MRI sequence to diagnose DCM

    MRI sensitivity to determine DMC?

    Is it possible to make some diagnostic criteria for DCM?

    At what point should myelopathy diagnosis be given, once MRI changes, or once signs/symptoms?

    What is the Radiological or MRI finding?  

    What are the clinical sign and symptom?  What are radiological or MRI finding?  What are the others relevant finding by blood testing and others?

    What should be the first line investigation in the diagnosis of degenerative cervical myelopathy? 

    How do we define DCM?   Are there imaging parameters that help to diagnose the disease?

    What is the best diagnostic modality?

    Can an easy method of diagnosis be devised for GP's / NHS physiotherapists to use?

    Which is the most important diagnostic tool to use first in this pathology 

    Functional neuroimage, neuroelectrophysiology and gait analysis may help for precise diagnosis.

    What is the accurate level diagnosis of DCM? 

    Which is the minimal/optimal clinical work up for diagnosis of DCM?  Does routine MRI provide definitive confirmation of diagnosis?  Is 1/1,5 Tesla MRI enough for diagnosis of DCM?

    Does diagnosis correlate with symptoms

    What was used in addition to exam for diagnosis ie MRI, EMG

    Clear definition of mri findings. Clear diagnostic imaging criteria   In addition to clear clinical criteria

    Ideal diagnostic measures, presumably T2 or STIR MRI sequences in the routine setting  ideal research measures for DCM, presumably DWI, perhaps cine sequences  components of dynamic changes of the stenosis  multilevel stenosis, grading of the relevance


    How to effectively define the diagnosis of sympathetic type of DCM ?

    How can we assess the severity of the DCM based on the radiologic findings? 

    Objective criteria for clinical diagnosis. 

    What is the standard method of diagnosis for DCM?

    What are the most appropriate role for imaging for detecting DCM?

    Diagnostic and predictive biomarkers for DCM

    Can DCM be diagnosed with radiographic findings?

    Which is best modality to diagnose early so that further disease progress can be halted.  

    What are valid methods of diagnosing degenerative cervical myelopathy?

    International diagnostic criteria

    What are the minimal imaging requisites that should be considered for the diagnosis of DCM

    What biomarkers are there to detect dcm?

    What er the clinical criteria for DCM?  What are the diagnostic criteria for DCM?  

    What are the image criteria for DCM?  What are the clinical criteria for DCM?

    What symptoms and or signs are needed to be considered to have dcm..

    Can we standardize the definition and improve the early differential diagnosis?

    How useful is cervical MRI and which additional examinations have prognostic values? 

    Getting a Dx