POsterior Laminectomy and FIXation for Degenerative Cervical Myelopathy

Research summary

Degenerative Cervical Myelopathy (DCM) is a common condition caused when arthritic changes in the neck compress the spinal cord. It affects up to 2% of adults and causes numb and clumsy hands, imbalance, and bladder problems.  Often it continues to worsen with time and left untreated can lead to severe disability and paralysis.

The only current treatment for DCM is surgery, and a number of different operations are used. The aim of surgery is to create space for the spinal cord. Surgery is able to stop further deterioration and lead to some improvements.

For people who need DCM surgery from the back of their neck, the pressure on the spinal cord is relieved by removing part of the bone that surrounds the spinal cord called the laminae, a procedure called laminectomy.  In some cases, metal implants are placed in addition to laminectomy in order to stiffen the spine. This is called laminectomy and fusion. Both procedures have potential advantages and disadvantages. 

At present, we do not know which of these approaches is better and finding out whether one approach is superior is an important research priority, according to both patients and professionals.

The purpose of the POLYFIX-DCM trial is to address the following question using a randomised controlled trial (RCT): Does laminectomy alone or laminectomy with fusion lead to better recovery in patients undergoing surgery for DCM from the back?

Patients scheduled to undergo surgery to posterior surgery for DCM will be allocated to either of these treatments using a computer.  The aim is to recruit 394 patients.

Main inclusion criteria

  • Adult patients aged 18 or over
  • Diagnosis of DCM
  • Scheduled for surgery involving 2 or more laminae
  • Able to provide informed consent
  • Able to read and understand English

Main exclusion criteria

  • Mild, non-progressive DCM (defined as a mJOA score of >16)
  • Presentation in the context of acute trauma

Funders and sponsors

Funder: National institute for Health Research (NIHR)

Sponsors: Cambridge University Hospitals NHS Foundation Trust and The University of Cambridge

Chief investigator

Dr Mark Kotter

Contact details

Clinical Trials Coordinator: Saima Siddiqui 

Email: [email protected]

Trial Website: NIHR POLYFIX-DCM Trial

For further information on Degenerative Cervical Myelopathy, please visit www.myelopathy.org