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A protocol for developing screening criteria for degenerative cervical myelopathy: AO Spine Myelopathy.org RECODE-DCM

Spinal Cord (2026)Cite this article

Subjects

Abstract

Study design

Protocol

Objectives

Degenerative cervical myelopathy (DCM) is caused by degenerative changes of the spinal column that lead to progressive spinal cord compression. Early identification of DCM is paramount to ensure appropriate specialist referral, timely intervention, and optimal treatment outcomes. Unfortunately, diagnosis of DCM is often delayed and may be missed entirely. A lack of screening or referral criteria has been identified as a major contributor of diagnostic delay. The objective of this study is to outline the methodology that will be used to develop screening criteria for DCM.

Methods

We propose a three-step approach for establishing screening criteria for DCM using data-driven and expert-based methods that includes a combination of patient-reported symptoms and clinical signs obtained from physical examination. Our approach includes: (i) an initial scoping review of inclusion criteria used in DCM research studies; (ii) criteria generation through systematic reviews of the literature as well as surveys of individuals with lived experience and international multidisciplinary experts in DCM; and (iii) criteria reduction via a consensus process.

Conclusions

Our framework intends to foster the development of valid, reliable and sustainable screening criteria that could improve awareness of DCM, influence practice decisions and reduce delays to diagnosis .

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Fig. 1: Flowchart showing the three-step approach for developing screening criteria.
Fig. 2: Global heat map representing the geographical distribution of Diagnostic Criteria Incubator members.

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Data availability

This article reports a study protocol; no data have been generated as part of this work.

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Acknowledgements

Our research aligns with the AO Spine RECODE-DCM top research priority ‘Diagnostic Criteria’ selected by people living and working with DCM. For further information on how the process was conducted, why this question was prioritized, and global updates on currently aligned research, please visit https://www.aofoundation.org/spine/research/recode-dcm/research-priorities/3-diagnostic-criteria. This article and the broader efforts to establish diagnostic criteria for DCM are led by the RECODE-DCM Diagnostic Criteria Incubator Group and are part of the AO Spine RECODE-DCM 2.0 ACT-NOW for DCM initiative. The work is supported by AO Spine through the AO Spine Knowledge Forum Spinal Cord Injury, a focused group of international Spinal Cord Injury experts and Myelopathy.org, a global charity focused on DCM. AO Spine is a clinical division of the AO Foundation, an independent, medically-guided, not-for-profit organization based in Davos, Switzerland.

Author information

Authors and Affiliations

  1. Department of Neurology, Massachusetts General Brigham, Boston, MA, US

    Lindsay Tetreault

  2. University of Cambridge, Cambridge, UK

    Tanzil Rujeedawa, Lance A. Burn, Sybil Stacpoole & Benjamin M. Davies

  3. Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland

    Carl Zipser

  4. Duke University Medical Center, Durham, North Carolina, US

    Chad Cook

  5. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, US

    Konstantinos Margetis

  6. University of California Davis, Department of Neurosurgery, Sacramento, US

    Allan R. Martin

  7. Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia

    David B. Anderson

  8. Division of Bioknesiology and Physical Therapy, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, CA, US

    Justin M. Lantz

  9. Hounslow and Richmond Community Healthcare, London, UK

    Julia Tabrah

  10. Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, 68198, USA

    Jamie RF Wilson

  11. Department of Orthopaedics, Centro Hospitalar do Porto—Hospital deSanto Antonio, Largo Prof. Abel Salazar, Porto, 4099-001, Portugal

    Ricardo Rodrigues-Pinto

  12. Professor of Orthopedics and Traumatology, University del Desarrollo, Clinica Alemana de Santiago, Vitacura, Chile

    Ratko Yurac

  13. Department of Public Health and Sports Science, University of Exeter, Exeter, UK

    Lianne Wood

  14. Department of Neurology, University of Utah, Salt Lake City, UT, US

    Ligia Onofrei

  15. Auckland Spine Surgery Centre; Active Living and Rehabilitation: Aotearoa New Zealand; Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand

    Rohil V. Chauhan

  16. Institute of Clinical Medicine, The Artic University of Norway, Tromsø, Norway

    Tore K. Solberg

  17. Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    James Harrop

  18. Department of Family Medicine, McMaster University, Hamilton, ON, USA

    Jamie Milligan

  19. Department of Physiotherapy, Beaumont Hospital, Dublin, Ireland

    Caroline Treanor

  20. KITE Research Institute and Toronto Rehabilitation Institute, University Health Network, and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Julio C. Furlan

  21. James J. Peters Veterans Affairs Medical Center, Icahn School of Medicine at Mount Sinai, Bronx, USA

    Noam Y. Harel

  22. The Hong Kong Neurosurgical Society; Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong

    Michael W. Y. Lee

  23. New Hall Hospital, Salisbury, UK

    Mike Hutton

  24. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Brian K. Kwon

  25. Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK

    Mark Kotter

  26. Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Michael G. Fehlings

Authors
  1. Lindsay Tetreault
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  2. Tanzil Rujeedawa
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  3. Lance A. Burn
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  4. Carl Zipser
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  5. Chad Cook
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  6. Konstantinos Margetis
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  7. Allan R. Martin
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  8. David B. Anderson
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  9. Justin M. Lantz
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  10. Julia Tabrah
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  11. Jamie RF Wilson
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  12. Ricardo Rodrigues-Pinto
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  13. Ratko Yurac
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  14. Lianne Wood
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  15. Ligia Onofrei
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  16. Rohil V. Chauhan
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  17. Tore K. Solberg
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  18. James Harrop
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  19. Sybil Stacpoole
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  20. Jamie Milligan
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  21. Caroline Treanor
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  22. Julio C. Furlan
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  23. Noam Y. Harel
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  24. Michael W. Y. Lee
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  25. Mike Hutton
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  26. Brian K. Kwon
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  27. Mark Kotter
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  28. Michael G. Fehlings
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  29. Benjamin M. Davies
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Contributions

LT, CZ, ARM and BD: conceptualization, methodology, writing – original draft, writing – review and editing, visualization, and supervision. TR and LAB: methodology, writing – original draft, writing – review and editing, visualization. CC, KM, DBA, JML, JT, JRFW, RRP, RY, LW, LO, RVC, TKS, JH, SS, JM, CT, JCF, NYH, MWYL, MH, BKK, MK and MGF: writing – review and editing.

Corresponding author

Correspondence to Lindsay Tetreault.

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Competing interests

The authors declare no competing interest.

Ethics & dissemination

Ethical approval was obtained for all methods from the University of Cambridge Human Biology Research Ethics Committee HBREC.2023.19. The study is led by an incubator group of multidisciplinary healthcare professionals and people with lived experience. The study involves patients/public with informed consent through surveys of individuals with lived experience, and international experts in DCM.

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Tetreault, L., Rujeedawa, T., Burn, L.A. et al. A protocol for developing screening criteria for degenerative cervical myelopathy: AO Spine Myelopathy.org RECODE-DCM. Spinal Cord (2026). https://doi.org/10.1038/s41393-026-01183-4

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