Study looks at use of riluzole as an adjunct to surgery for degenerative cervical myelopathy


Neuroprotective drug may benefit patients with DCM


Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction among adults worldwide.  This condition is characterized by stenosis, or compression of the cervical spinal cord and manifests in weakness and incoordination of both the upper and lower extremities.  As patients age, osteoarthritis of the facet joints and ligaments makes this compression worse.  

Traditionally, the only treatment of DCM has been surgery, with the goal of giving more room for the spinal cord.  Though surgery can be helpful, as many as 25% of patients may not improve with surgery, or may get worse.  Additionally, some patients may not be surgical candidates due to comorbidities.

In this multicenter, double-blind, placebo-controlled, randomized, phase 3 trial, researchers investigate the use of riluzole, an anticonvulsant medication currently approved by the US Food and Drug Administration for the treatment of amyotrophic lateral sclerosis (ALS) in patients undergoing surgery for DCM. Though they did not find a significant difference in the primary outcome – namely change in the modified Japanese Orthopaedic Association (mJOA) scale at 6 months after surgery comparing patients who received riluzole and those that did not -- they did find a significant improvement in patients’ neck pain.  

"This is an important study as it shows that there are adjuncts to surgery that may prove helpful for this important patient population," said Muhammad Abd-El-Barr, MD, PhD, assistant professor of neurosurgery at Duke. "Another possibility is that these adjuncts may prove helpful in those patients who cannot undergo surgery."

Christopher Shaffrey, MD, professor of neurosurgery and chief of the Spine Division at Duke, was involved in this work while he was at the University of Virginia.  “At Duke, we will continue some of this important study of riluzole in both traumatic and non-traumatic spine injuries,” he said.  

Duke is currently enrolling patients in several clinical trials looking at riluzole and other neuroprotective drugs. Duke Neurosurgery researchers are also collaborating with bioengineers and neuroscientists in developing novel techniques to treat spinal cord injuries in animal models, translational studies, and clinical studies.  “As a premier research university, we are well poised to make significant inroads into this important disease entity which effects a significant number of people,” said Abd-El-Barr. 

The study was published online in The Lancet Neurology, December 22, 2020.