Prehabilitation in Degenerative Cervical Myelopathy: An Underexplored Opportunity to Optimize Outcomes

Abstract

Letter to Editor [Excerpt] While degenerative cervical myelopathy (DCM) is the most prevalent cause of non-traumatic spinal cord dysfunction in adults worldwide, it remains under-recognized in clinical practice. Globally, the average time from symptom onset to diagnosis is 15 months (Malone et al., 2025). DCM is marked by progressive spinal cord compression, neuronal apoptosis, and chronic inflammation, often leading to neurological deficits including gait and balance disturbances, hand dysfunction, and muscle weakness (Malone et al., 2025). In moderate to severe cases, surgical decompression is advised to stop further neurological deterioration (Fehlings et al., 2017). However, surgery alone does not address the associated physical deconditioning and musculoskeletal sequelae, such as reduced cervical mobility, impaired walking capacity, muscle weakness and atrophy, dexterity loss, and pain that accompany prolonged DCM. Furthermore, symptoms often persist following surgery, with 25-50% of patients experiencing minimal improvement; failing to achieve the minimally clinically important difference for functional or quality-of-life outcomes (Jaja et al., 2023). This raises an important question that remains largely unexplored: could prehabilitation improve outcomes for individuals with DCM?