Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes

• Published in: PloS one Vol. 13; no. 12; p. e0207709
• Main Authors: Hilton, Bryn, Tempest-Mitchell, Jennifer, Davies, Benjamin, Kotter, Mark
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.12.2018; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Care and treatment; Central nervous system diseases; Cervical Vertebrae; Clinical medicine; Clinical outcomes; Cohort Studies; Delayed Diagnosis; Development and progression; Diagnosis; Family physicians; Female; Health care; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Medical diagnosis; Medical personnel; Medical referrals; Medicine and Health Sciences; Middle Aged; Neck pain; Neurodegenerative Diseases - diagnosis; Neurodegenerative Diseases - diagnostic imaging; Neurodegenerative Diseases - surgery; Neurological complications; Neurosciences; Neurosurgery; NMR; Nuclear magnetic resonance; Outcome and process assessment (Medical care); Pain; Patients; People and Places; Physicians; Primary care; Reflexes; Research and Analysis Methods; Spasticity; Specialization; Spinal cord; Spinal Cord Compression - diagnosis; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - surgery; Spinal cord diseases; Spinal surgery; Surgery; Treatment Outcome; Young Adult; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0207709

Degenerative Cervical Myelopathy [DCM] often presents with non-specific symptoms and signs. It progresses insidiously and leads to permanent neurological dysfunction. Decompressive surgery can halt disease progression, however significant delays in diagnosis result in increased disability and limit recovery. The nature of early DCM symptoms is unknown, moreover it has been suggested incomplete examination contributes to missed diagnosis. This study examines how DCM is currently assessed, if assessment differs between stages of healthcare, and whether this influences patient management. Retrospective cohort study. Cervical MRI scans (N = 1123) at a tertiary neurosciences center, over a single year, were screened for patients with DCM (N = 43). Signs, symptoms, and disease severity of DCM were extracted from patient records. Patients were considered at 3 phases of clinical assessment: primary care, secondary care, and surgical assessment. Upper limb paraesthesia and urinary dysfunction were consistently the most and least prevalent symptoms respectively. Differences between assessing clinicians were present in the reporting of: limb pain (p<0.005), objective limb weakness (p = 0.01), hyperreflexia (p<0.005), Hoffmann reflex (p<0.005), extensor plantar reflex (p = 0.007), and lower limb spasticity (p<0.005). Pathological reflexes were least frequently assessed by primary care doctors. DCM assessment varies significantly between assessors. Reporting of key features of DCM is especially low in primary care. Incomplete assessment may hinder early diagnosis and referral to spinal surgery.