Should we screen retired contact sport athletes for early signs of degenerative cervical myelopathy?

Abstract

Degenerative cervical myelopathy (DCM) is a clinical condition of upper motor neuron lesion signs, that is confirmed with advanced imaging demonstrating compression of the spinal cord in the cervical spine.1 Common symptoms of DCM include loss of upper and lower limb strength and coordination, gait dysfunction, and bladder and bowel dysfunction.2 The difference between DCM and other sports-related spinal cord injuries is that DCM results from spinal cord compression due to gradual degenerative changes, making detection more difficult. DCM is a leading cause of spinal cord injury2 and can result in catastrophic symptoms and lifelong disability if left untreated.2 While the mean prevalence of DCM is low in the general population at around 2.22% (95% CI 0.44% to 2.68%), specific populations are at greater risk, such as older adults (>79 years of age) who have a mean prevalence of 4.16% (95% CI 0.82% to 5.03%).3 People from Asia-Pacific and African regions are also reported to have an increased prevalence of DCM and/or cervical stenosis.4 A recent review of the risk factors for the development of DCM reported that long-term participation in contact sports may be associated with increased rates of early spinal degeneration as well as spinal cord injury secondary to cervical spinal stenosis.5 While the exact mechanism remains unclear, it is possible that the combination of repeated mechanical loading and increased prevalence of cervical injuries in contact sport athletes is a cause of early spinal degeneration. In particular, premature cervical spondylosis can lead to DCM in some contact sport athletes.5 This commentary explores the potential benefits of screening contact sport athletes for DCM to facilitate early diagnosis and intervention. Unlike other spinal cord injuries, DCM does not require a traumatic event and can have an insidious onset, making diagnosis and detection …