Degenerative Thoracic Myelopathy: A Scoping Review of Epidemiology, Genetics, and Pathogenesis.

Abstract

Literature Review. Myelopathy affecting the thoracic spinal cord can arise secondary to several aetiologies which have similar presentation and management. Consequently, there are many uncertainties in this area, including optimal terminology and definitions. Recent collaborative cervical spinal research has led to the proposal and subsequent community adoption of the name <i>degenerative cervical myelopathy(DCM)</i>, which has facilitated the establishment of internationally-agreed research priorities for DCM. We put forward the case for the introduction of the term <i>degenerative thoracic myelopathy(DTM)</i> and <i>degenerative spinal myelopathy(DSM)</i> as an umbrella term for both <i>DCM</i> and <i>DTM</i>. Following PRISMA guidelines, a systematic literature search was performed to identify degenerative thoracic myelopathy literature in Embase and MEDLINE. Conditions encompassed within DTM include thoracic spondylotic myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, calcification of ligaments, hypertrophy of ligaments, degenerative disc disease, thoracic osteoarthritis, intervertebral disc herniation, and posterior osteophytosis. The classic presentation includes girdle pain, gait disturbance, leg weakness, sensory disturbance, and bladder or bowel dysfunction, often with associated back pain. Surgical management is typically favoured with post-surgical outcomes dependent on many factors, including the causative pathology, and presence of additional stenosis. The clinical entities encompassed by the term DTM are interrelated, can manifest concurrently, and present similarly. Building on the consensus adoption of <i>DCM</i> in the cervical spine and the recent proposal of <i>degenerative cervical radiculopathy(DCR)</i>, extending this common nomenclature framework to the terms <i>degenerative spinal myelopathy</i> and <i>degenerative thoracic myelopathy</i> will help improve recognition and communication.