Podcast Episode 7: Novel therapies
Novel therapies for DCM—the topic of Episode 7 of the AO Spine RECODE-DCM Podcast series. What are the limitations and potential advances of current therapies, how can novel experimental treatment paradigms deliver progress, how could strategies for neurorehabilitation advance the field? Ben Davies and Michelle Starkey put the questions to Ricardo Rodrigues-Pinto, Annie Wandycz, Mark Kotter, and Julio Furlan.
Current evidence and reason for uncertainties
No systematic reviews, scoping reviews or guidelines identified.
Source of uncertainty
Other healthcare professionals
People with DCM and their supporters
* This list shows the original survey submission(s) that informed the indicative uncertainties and the resulting priority question.
What if any medical management technoligies are promising and can be developed?
Is there any modality that can help with surgery ... steroids, other medications, stem cells?
Are there adjunct neuroprotective/medical strategies to help improve outcome with surgical decompression?
Are we close to having individualized treatments for DCM such as monoclonal antibodies or other biologic treatments for specific genes involved, etc?
Any medical treatments available?
Proper farmacological evolution/assistance
What are the new studies about medication for example with the use of Riluzole
What novel treatments are currently in the works for DCM? Are these likely to replace the gold standard treatments?
Is there any treatment that can prevent my wife from having another surgery?
Are there drugs or intramedullary strategies that could improve outcomes?
Role of neuroprotective perioperative means
What would be the role of steroids, neurotropic agents like pregabalin and Riluzole in the management of DCM?
Is there a role for interventional injections eg epidural in managing some of the symptoms of cervical myelopathy?
What treatments from the spinal cord injury literature are effective in patients with DCM?
What medicines or supplements are best?
Which pharmacological approach is the best by evidence
There are so many new things today/. Can stem cell research help spinal condition's? pain.
Evolution of symptoms with proper farmacology treatment in non-surgical stages
most patients ask, if I leave it like that, will it get worse? will I lose ability to walk etc? -- Can we reliably prevent worsening of DCM symptoms with drugs (neuroprotection)
Any other treatments rather than surgery or perhaps better recovery after surgery with use of drugs
Would cortical stimulation aid recovery post surgery in the same way that it is being used in spinal cord injury
How can we do some prevention of the degenerescence of the spine in myelopathy (pharmacological, neurosurgical...)
What is the optimal periprocedural medical management?
Research to find methods to slow progression.
Are there medications or treatments that can delay the onset of DCM?
After surgery is there anything else being researched to help improve mobility.
Role of gene therapy
Any research projects available. EG new research into drug which improves function of people with paralysis.
New medical management of DCM and its symptoms
Improvement in DCM related paralysis either surgery or medically
What is the future of DCM treatment. Preventive treatment feasible?
Use of neuroprotective strategies during decompressive surgery for DCM
Would introduction of stem cells restore any function ?
Would introduction of growth factors stimulate return of function with or without surgical intervention?
Research into preventing deterioration would be very welcome.
Is stem cell therapy ever going to be introduced to counteract the damage done by this type of degeneration?
Some medical treatment that can modulate evolution
I'd like to see a cure. I'd like to see one other option besides surgery .
Is there anything new? Meds? Non operative treatments?
Any drugs that can help cure myelopathy after decompression
Can DCM benefit from any alternative treatments?
Can DCM benefit from advances found in other areas, perhaps treatment of diabetic neuropathy for instance?
Do NSAIDS or pregabalines affect/retard the course/progression of DCM?
I have just been diagnosed and was alarmed to see that there is no treatment, apart from surgery. Will there eventually be some kind of drug treatment which can slow down the degeneration and progress of the condition/
Does i.v. stem cell therapy after decompressive surgery result in better neurological outcomes than decompressive surgery alone?
Is there anything new? Besides medicine. Is there any new treatment? Stem cells?
A new , non operative way to decompress the spinal cord.
What is the role of staminal cells?
Which spinal cord pathways are preserved, and what is their capacity to restore function? Can electrical stimulation of the spinal cord/brain be used to restore function?
WHAT SHOULD BE THE SEQUENCE OF DRUGS TO BE STARTED IN THESE PATIENTS AND FOR HOW LONG?
Is there a role of antioxidants, and other medication in the medical management of DCM.
What is the role of epidural stimullation? What is the role of vascular growth factors?
What role do antioxidants have in the post operative recovery from DCM?
5. When can I expect stem cells ? Would they be helpful in regeneration?
A treatment that would regenerate the disc.
3-Are there any co-adjuvant therapies (drugs and/or physical therapies) that can help us improve outcomes in these patients?
Intraoperative adjuncts to improve surgical outcomes
Is this a condition for which neuromodulation after surgery combined with rehabilitation could lead to neurological improvement.
How do we improve outcome after surgery? (Regeneration)
What clinical trials are being held to look for cures/recovery?
How to improve the outcome after surgery
Role of regenerative medicine in this setting
Basic science restorative technologies
Will there ever be a cure or way to stop the progress of this condition?
What, if any, new treatments such as stem cell research is on the horizon for this disease.
Stem cells biological markers
Stem cells can be an alternative treatment?
Can stem cells help restore lost function in cases of severe DCM?
Any role of stem cells?
Stem cells? Future options??
Role of stem cells in patients who cannot undego surgery
-- nano fabricated scaffolds with or without stem cells, can they play a role in treatment of both compression (perhaps canal remodelling) or DCM symptoms (neurorepair) ?
Are there any drugs effective in chronic ischaemia of spinal cord?
Can pharmacological interventions provoke reinnervation if motor function lost?
Can we use complement inhibition in the control of progressive DCM?
Continue to explore alternate treatment methods
Is there a role for treatment, such as, stem cells?
It's the effect of stem cells on the damage area
Recent updates and new therapeutic solutions regarding the devastating late myelomalacic myelopathy? What Can we offer when spinal cord atrophy has evolved so much that neural senescence is in progress.
Role of vitamin B supplementation on clinical course
What role Regenerative Medicine and stem cell have to play in such disease?
Will there ever be a cure? Is any research actually being done?
What hope is there for damaged spinal cord not fixed by fusion (c5/6)? Is there somewhere in the world where the best treatment is available? What type of research is being done in this area?
Is there evidence or potential for stem cell=based treatment in DCM?
What is the consensus on neuroprotection in treatmenet of patients with DCM?
Neuroprotective strategies during decompressive surgery for DCM
ARE ALTERNATIVE MEDICINES ANY USE, EG CANNABIS?
Is stem cell therapy a viable alternative to surgery?
After surgery, what drugs will help the patient regain function quickly?
Does drug ... treatment help?
New research on nerve repair
Are Amantadin or steroids or any other treatment is useful in this disease?
What is the role of THC and CBD in the treatment of DCM?
Addition mediation could be a effective treatment.
Value of steroids
When do we consider using steroids?
1. Is there a role of steroids in DCM
Do steroids have a role in the treatment of DCM?
What is the role of perioperative steriods in patient undergoing surgery for DCM?
W..Effect of injections of steroids?
Is steroid injections effective in slowing symptoms of DCM?