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A Multicenter Registry-Based Study Across the Spectrum of Degenerative Cervical Myelopathy (DCM-RB)
A Multicenter Registry-Based Study of Degenerative Cervical Myelopathy Across the Full Disease Spectrum Based on a Disease-Specific Registry Platform and Linked Biobank
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Degenerative cervical myelopathy (DCM) is an important cause of chronic spinal cord dysfunction in adults. The disease spectrum includes non-myelopathic degenerative cervical cord compression, which may occur with or without radiculopathy, and clinically established mild, moderate, or severe DCM. Current clinical management and research increasingly require standardized longitudinal data collection across different disease stages, treatment pathways, imaging phenotypes, and functional states.
This study will establish a multicenter, prospective, longitudinal, observational registry based on a disease-specific registry platform and linked biobank. The study itself will not interfere with clinical treatment decisions. Participants will receive routine clinical care under real-world practice, including observation, nonsurgical treatment, surgery, or follow-up after previous cervical spine surgery as clinically indicated.
All enrolled participants will enter the same registry platform and undergo standardized baseline assessment, scheduled follow-up, and event-driven supplemental data collection. The registry will use a two-level data structure consisting of a core dataset and optional extended datasets. The core dataset includes demographic characteristics, comorbidities, disease history, neurological examination, objective functional tests, mJOA, JOA, Nurick grade, Neck Disability Index, SF-36v2, cervical MRI findings, treatment exposure, treatment changes, hospitalization, surgery, readmission, reoperation, adverse events, and major functional events.
Extended datasets may include quantitative MRI, diffusion tensor imaging, T2 mapping, electrophysiology, standardized blood biomarkers, PBMC-based immune profiling, omics assays, optional surgically obtained tissue, and structured traditional Chinese medicine syndrome assessment, depending on center capability, ethical approval, funding, and assay validation. The recommended core MRI protocol includes conventional cervical MRI, DTI, and T2 mapping. The core blood collection protocol includes serum, EDTA plasma, buffy coat, and whole blood for biomarker assays and correction variables.
Scheduled follow-up visits are planned at baseline, 3 months, 6 months, 12 months, 24 months, and 36 months, with extension to 60 months when feasible. Event-driven supplemental data collection will be performed when participants develop new myelopathic signs, clinically meaningful neurological deterioration, treatment escalation, surgery, readmission, reoperation, or other major functional events.
The primary endpoint is a composite endpoint of clinical deterioration or disease progression across the spectrum of degenerative cervical cord compression and DCM. The registry will support natural history research, clinical trajectory analysis, treatment pathway evaluation, biomarker exploration, nested prognostic modeling, and real-world outcome evaluation.
Studietype
Inschrijving (Geschat)
Contacten en locaties
Studiecontact
- Naam: He Yin
- Telefoonnummer: +8615901123675
- E-mail: milkywaymoon@163.com
Studie Contact Back-up
- Naam: Bo Xu
- Telefoonnummer: +8615537762669
- E-mail: xb202212@163.com
Studie Locaties
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Beijing Municipality
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Beijing, Beijing Municipality, China, 100102
- Wangjing Hospital, China Academy of Chinese Medical Sciences
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Contact:
- Yin He
- Telefoonnummer: +8615901123675
- E-mail: milkywaymoon@163.com
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Hoofdonderzoeker:
- Liguo Zhu
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Hoofdonderzoeker:
- He Yin
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion Criteria:
- Age 18 years or older.
- Cervical MRI confirms cervical spinal cord compression caused by degenerative pathology, including but not limited to disc protrusion or bulging, osteophyte formation, ligamentum flavum hypertrophy or ossification, ossification of the posterior longitudinal ligament, degenerative cervical canal stenosis, or other degenerative compressive factors.
- At least one cervical level meets one or more of the following imaging criteria: partial or complete disappearance of the cerebrospinal fluid space around the spinal cord, direct contact between the spinal cord and degenerative compressive structures, focal spinal cord indentation, flattening or deformation, or other recognized imaging manifestations of degenerative cervical cord compression.
- Meets one of the following clinical phenotypes: non-myelopathic degenerative cervical cord compression, with or without clinical radiculopathy; or clinically and radiologically confirmed mild, moderate, or severe degenerative cervical myelopathy.
- Able to complete baseline core assessments and willing to participate in longitudinal follow-up.
- Provides written informed consent. Additional consent may be obtained for specific biospecimen types or nested substudies.
Exclusion Criteria:
- Cervical spinal cord compression or myelopathy mainly caused by non-degenerative etiologies, such as acute trauma, tumor, infection, inflammatory or demyelinating disease, vascular lesion, obvious congenital malformation, or other non-degenerative spinal cord disease.
- Presence of a dominant other neurological disease or severe psychiatric or cognitive disorder that, in the investigator's judgment, would clearly interfere with DCM-related neurological functional assessment or make reliable follow-up impossible.
- Objective inability to complete the core imaging assessment or core follow-up and judged by the investigator to be unsuitable for inclusion in the main registry cohort.
- Refusal to sign informed consent or explicit refusal of core data collection and follow-up.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
Interventie / Behandeling |
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A1: Non-myelopathic Degenerative Cervical Cord Compression Without Radiculopathy
Adults with MRI-confirmed non-myelopathic degenerative cervical cord compression without clinical radiculopathy.
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Participants will receive routine clinical care according to real-world clinical decision-making.
The study does not assign or mandate surgical or nonsurgical treatment.
Clinical data, imaging data, follow-up outcomes, adverse events, and biospecimens will be collected according to the registry protocol.
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A2: Non-myelopathic Degenerative Cervical Cord Compression With Radiculopathy
Adults with MRI-confirmed non-myelopathic degenerative cervical cord compression with clinical radiculopathy.
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Participants will receive routine clinical care according to real-world clinical decision-making.
The study does not assign or mandate surgical or nonsurgical treatment.
Clinical data, imaging data, follow-up outcomes, adverse events, and biospecimens will be collected according to the registry protocol.
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B1: Mild Degenerative Cervical Myelopathy
Adults with clinically and radiologically confirmed degenerative cervical myelopathy with mild neurological impairment, defined as mJOA score 15-17.
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Participants will receive routine clinical care according to real-world clinical decision-making.
The study does not assign or mandate surgical or nonsurgical treatment.
Clinical data, imaging data, follow-up outcomes, adverse events, and biospecimens will be collected according to the registry protocol.
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B2: Moderate Degenerative Cervical Myelopathy
Adults with clinically and radiologically confirmed degenerative cervical myelopathy with moderate neurological impairment, defined as mJOA score 12-14.
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Participants will receive routine clinical care according to real-world clinical decision-making.
The study does not assign or mandate surgical or nonsurgical treatment.
Clinical data, imaging data, follow-up outcomes, adverse events, and biospecimens will be collected according to the registry protocol.
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B3: Severe Degenerative Cervical Myelopathy
Adults with clinically and radiologically confirmed degenerative cervical myelopathy with severe neurological impairment, defined as mJOA score 0-11.
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Participants will receive routine clinical care according to real-world clinical decision-making.
The study does not assign or mandate surgical or nonsurgical treatment.
Clinical data, imaging data, follow-up outcomes, adverse events, and biospecimens will be collected according to the registry protocol.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Time to First Composite Clinical Deterioration or Disease Progression Event
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first occurrence of any component of the predefined composite clinical deterioration or disease progression endpoint.
The composite endpoint is considered to have occurred when a participant first experiences one or more of the following events: progression from non-myelopathic degenerative cervical cord compression to clinical degenerative cervical myelopathy, a decrease in mJOA score of at least 2 points from baseline; a new clinically meaningful neurological deficit or definite myelopathic sign; predefined worsening in symptom/function state; treatment escalation due to objective disease progression; new sphincter dysfunction; loss of independent ambulation; or another major functional event adjudicated by investigators.
Participants without any component event will be censored at the last available follow-up.
The unit of measure is months from baseline to the first composite event.
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Baseline to 36 months
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Time to First Treatment Pathway Conversion
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first treatment pathway conversion.
Treatment pathway conversion is defined as a change from observation or regular follow-up to nonsurgical treatment, from observation or nonsurgical treatment to surgery, or another clinically justified treatment strategy change due to symptom worsening, neurological deterioration, imaging progression, or other objective disease progression.
Participants without treatment pathway conversion will be censored at the last available follow-up.
The unit of measure is months from baseline to first treatment pathway conversion.
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Baseline to 36 months
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Time to First Cervical Spine Surgery During Follow-up
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first cervical spine surgery related to degenerative cervical cord compression or degenerative cervical myelopathy during follow-up.
Cervical spine surgery includes cervical decompression, fusion, laminoplasty, or other DCM-related cervical surgical procedures.
Participants without cervical spine surgery will be censored at the last available follow-up.
The unit of measure is months from baseline to first cervical spine surgery.
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Baseline to 36 months
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Time to First DCM-related Readmission
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first readmission related to degenerative cervical myelopathy, degenerative cervical cord compression, postoperative complications, disease recurrence, symptom aggravation, or other cervical spine-related causes.
Participants without DCM-related readmission will be censored at the last available follow-up.
The unit of measure is months from baseline to first DCM-related readmission.
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Baseline to 36 months
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Time to First Cervical Spine Reoperation or Additional Cervical Intervention
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first cervical spine reoperation or additional cervical intervention related to degenerative cervical myelopathy, degenerative cervical cord compression, postoperative complications, disease recurrence, adjacent segment problems, or other cervical spine-related causes.
Participants without reoperation or additional cervical intervention will be censored at the last available follow-up.
The unit of measure is months from baseline to first reoperation or additional cervical intervention.
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Baseline to 36 months
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Time to First Composite Major Functional Deterioration Event
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first occurrence of any component of the predefined composite major functional deterioration endpoint.
The composite endpoint is considered to have occurred when a participant first experiences new or obviously worsened sphincter dysfunction, loss of independent ambulation, serious fall-related consequences, marked decline in activities of daily living, or another clinically meaningful major functional deterioration event adjudicated by investigators.
Participants without any component event will be censored at the last available follow-up.
The unit of measure is months from baseline to first composite major functional deterioration event.
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Baseline to 36 months
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Percentage of Participants With Serious Adverse Events
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the percentage of participants who experience at least one serious adverse event during follow-up.
Serious adverse events include events resulting in death, life-threatening events, hospitalization or prolonged hospitalization, persistent or significant disability, or other medically important events.
The unit of measure is the percentage of participants.
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Baseline to 36 months
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Percentage of Surgically Treated Participants With Surgical Adverse Events
Tijdsspanne: From surgery to 36 months after baseline
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This outcome will be reported as the percentage of surgically treated participants who experience at least one surgical adverse event.
Surgical adverse events may be recorded using SAVES-V2 or an equivalent structured adverse event recording tool when feasible.
The unit of measure is percentage of surgically treated participants.
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From surgery to 36 months after baseline
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Percentage of Participants With All-Cause Mortality
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the percentage of participants who die from any cause during follow-up.
The date of death and main cause of death will be recorded when available.
The unit of measure is the percentage of participants.
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Baseline to 36 months
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Andere uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Change From Baseline in mJOA Score
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the modified Japanese Orthopaedic Association score at each scheduled follow-up visit.
The mJOA score is a clinician-administered neurological function scale for degenerative cervical myelopathy.
The unit of measure is points on the mJOA scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in JOA Score
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the Japanese Orthopaedic Association score at each scheduled follow-up visit.
The unit of measure is points on the JOA scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in Nurick Grade
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in Nurick grade at each scheduled follow-up visit.
The Nurick grade is an ordinal clinician-rated measure of gait-related functional impairment in cervical myelopathy.
The unit of measure is grade on the Nurick scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in Neck Disability Index Score
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the Neck Disability Index score at each scheduled follow-up visit.
The Neck Disability Index is a patient-reported questionnaire assessing neck-related disability.
The unit of measure is points on the Neck Disability Index scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in SF-36v2 Physical Component Summary Score
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the SF-36v2 Physical Component Summary score at each scheduled follow-up visit.
The SF-36v2 is a patient-reported health-related quality of life questionnaire.
The unit of measure is points on the SF-36v2 Physical Component Summary scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in SF-36v2 Mental Component Summary Score
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the SF-36v2 Mental Component Summary score at each scheduled follow-up visit.
The SF-36v2 is a patient-reported health-related quality of life questionnaire.
The unit of measure is points on the SF-36v2 Mental Component Summary scale.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in 10-Second Grip-and-Release Test Count
Tijdsspanne: Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in the number of grip-and-release cycles completed within 10 seconds at each scheduled follow-up visit.
The 10-second grip-and-release test is an objective hand function test.
The unit of measure is the number of cycles.
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Baseline, 3 months, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in 10-Meter Walking Speed
Tijdsspanne: Baseline, 12 months, 24 months, and 36 months, or according to clinical follow-up availability
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This outcome will be reported as the change from baseline in walking speed measured by the 10-meter walking test at each scheduled follow-up visit.
The unit of measure is meters per second.
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Baseline, 12 months, 24 months, and 36 months, or according to clinical follow-up availability
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Change From Baseline in Maximum Spinal Cord Compression
Tijdsspanne: Baseline, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in maximum spinal cord compression measured on cervical MRI.
Maximum spinal cord compression will be assessed using offline quantitative MRI measurement.
The unit of measure is percentage.
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Baseline, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in Maximum Canal Compromise
Tijdsspanne: Baseline, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in maximum canal compromise measured on cervical MRI.
Maximum canal compromise will be assessed using offline quantitative MRI measurement.
The unit of measure is percentage.
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Baseline, 12 months, 24 months, and 36 months
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Change From Baseline in Spinal Cord Cross-Sectional Area
Tijdsspanne: Baseline, 12 months, 24 months, and 36 months, when available
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This outcome will be reported as the change from baseline in spinal cord cross-sectional area measured on cervical MRI at the target compression level.
The unit of measure is square millimeters.
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Baseline, 12 months, 24 months, and 36 months, when available
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Change From Baseline in DTI Fractional Anisotropy
Tijdsspanne: Baseline, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in fractional anisotropy measured by cervical spinal cord diffusion tensor imaging at the target level or predefined region of interest.
The unit of measure is fractional anisotropy value.
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Baseline, 12 months, 24 months, and 36 months
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Change From Baseline in T2 Mapping Value
Tijdsspanne: Baseline, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in cervical spinal cord T2 mapping value measured at the target level or predefined region of interest.
The unit of measure is milliseconds.
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Baseline, 12 months, 24 months, and 36 months
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Change From Baseline in Plasma Neurofilament Light Chain Concentration
Tijdsspanne: Baseline, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in plasma neurofilament light chain concentration measured in EDTA plasma.
The measurement tool is a blood biomarker assay.
The unit of measure is picograms per milliliter.
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Baseline, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in Serum Interleukin-6 Concentration
Tijdsspanne: Baseline, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in serum interleukin-6 concentration measured in serum.
The measurement tool is a blood biomarker assay.
The unit of measure is picograms per milliliter.
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Baseline, 6 months, 12 months, 24 months, and 36 months
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Change From Baseline in Plasma Brain-Derived Neurotrophic Factor Concentration
Tijdsspanne: Baseline, 6 months, 12 months, 24 months, and 36 months
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This outcome will be reported as the change from baseline in plasma brain-derived neurotrophic factor concentration measured in EDTA plasma.
The measurement tool is a blood biomarker assay.
The unit of measure is picograms per milliliter.
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Baseline, 6 months, 12 months, 24 months, and 36 months
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Time to First Worsening in Symptom and Functional State Category
Tijdsspanne: Baseline to 36 months
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This outcome will be reported as the time from baseline to the first worsening in the predefined symptom and functional state category.
Symptom and functional state will be classified by investigators using a predefined ordinal state category: S0, imaging compression without definite symptoms or signs; S1, radiculopathy-dominant state; S2, sensory-dominant state; S3, upper-limb motor or hand-function dominant state; S4, lower-limb or gait-dominant state; S5, mixed motor involvement; and S6, sphincter dysfunction or severe functional impairment.
"Worsening" is defined as a transition to a higher severity state category.
The unit of measure is months from baseline to the first worsening in the state category.
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Baseline to 36 months
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Medewerkers en onderzoekers
Onderzoekers
- Studie stoel: Liguo Zhu, Wangjing Hospital, China Academy of Chinese Medical Sciences
- Studie directeur: He Yin, Wangjing Hospital, China Academy of Chinese Medical Sciences
Publicaties en nuttige links
Algemene publicaties
- Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Aarabi B, Arnold PM, Brodke DS, Burns AS, Carette S, Chen R, Chiba K, Dettori JR, Furlan JC, Harrop JS, Holly LT, Kalsi-Ryan S, Kotter M, Kwon BK, Martin AR, Milligan J, Nakashima H, Nagoshi N, Rhee J, Singh A, Skelly AC, Sodhi S, Wilson JR, Yee A, Wang JC. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine J. 2017 Sep;7(3 Suppl):70S-83S. doi: 10.1177/2192568217701914. Epub 2017 Sep 5.
- Bednarik J, Kadanka Z, Dusek L, Novotny O, Surelova D, Urbanek I, Prokes B. Presymptomatic spondylotic cervical cord compression. Spine (Phila Pa 1976). 2004 Oct 15;29(20):2260-9. doi: 10.1097/01.brs.0000142434.02579.84.
- Yanez Touzet A, Bhatti A, Dohle E, Bhatti F, Lee KS, Furlan JC, Fehlings MG, Harrop JS, Zipser CM, Rodrigues-Pinto R, Milligan J, Sarewitz E, Curt A, Rahimi-Movaghar V, Aarabi B, Boerger TF, Tetreault L, Chen R, Guest JD, Kalsi-Ryan S, McNair AG, Kotter M, Davies B; AO Spine RECODE-DCM Steering Committee. Clinical outcome measures and their evidence base in degenerative cervical myelopathy: a systematic review to inform a core measurement set (AO Spine RECODE-DCM). BMJ Open. 2022 Jan 19;12(1):e057650. doi: 10.1136/bmjopen-2021-057650.
- Davies BM, Yang X, Khan DZ, Mowforth OD, Touzet AY, Nouri A, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Tetreault L, Kwon BK, Boerger TF, Rodrigues-Pinto R, Furlan JC, Chen R, Zipser CM, Curt A, Milligan J, Kalsi-Rayn S, Sarewitz E, Sadler I, Blizzard T, Treanor C, Anderson D, Fallah N, Hazenbiller O, Salzman C, Zimmerman Z, Wandycz AM, Widdop S, Reeves M, Raine R, Ryan SK, Malone A, Gharooni A, Wilson JR, Martin AR, Fehlings MG, McNair AGK, Kotter MRN; AO SPINE RECODE-DCM Steering Committee and AO Spine RECODE DCM Community. A minimum data set-Core outcome set, core data elements, and core measurement set-For degenerative cervical myelopathy research (AO Spine RECODE DCM): A consensus study. PLoS Med. 2024 Aug 22;21(8):e1004447. doi: 10.1371/journal.pmed.1004447. eCollection 2024 Aug.
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
- Biobank
- Natuurlijke geschiedenis
- Diffusie tensor beeldvorming
- Ziekteprogressie
- ADCC
- Degeneratieve cervicale myelopathie
- Patiëntenregistratie
- DCM
- T2-mapping
- Bloed biomarker
- mJOA
- Non-myelopathic degenerative cervical cord compression
- NMDCCC
- Asymptomatic degenerative cervical cord compression
- Cervical spinal cord compression
- Cervical spondylotic myelopathy
- Cervical MRI
- Traditional Chinese medicine syndrome
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- 2024YFC3507401
Plan Individuele Deelnemersgegevens (IPD)
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