YURAC BARRIENTOS, RATKO JOVAN
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YURAC BARRIENTOS, RATKO JOVAN
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yratko@udd.cl
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24436839000

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Targeting earlier diagnosis: What symptoms come first in Degenerative Cervical Myelopathy?

2023 , Colin F. Munro , YURAC BARRIENTOS, RATKO JOVAN , Zipser Carl Moritz , Michael G. Fehlings , Ricardo Rodrigues-Pinto , James Milligan , Konstantinos Margetis , Mark R. N. Kotter , Benjamin M. Davies , Andrea Martinuzzi

Background Degenerative cervical myelopathy (DCM) is a common and disabling condition. Early effective treatment is limited by late diagnosis. Conventional descriptions of DCM focus on motor and sensory limb disability, however, recent work suggests the true impact is much broader. This study aimed to characterise the symptomatic presentation of DCM from the perspective of people with DCM and determine whether any of the reported symptoms, or groups of symptoms, were associated with early diagnosis. Methods An internet survey was developed, using an established list of patient-reported effects. Participants (N = 171) were recruited from an online community of people with DCM. Respondents selected their current symptoms and primary presenting symptom. The relationship of symptoms and their relationship to time to diagnosis were explored. This included symptoms not commonly measured today, termed ‘non-conventional’ symptoms. Results All listed symptoms were experienced by >10% of respondents, with poor balance being the most commonly reported (84.2%). Non-conventional symptoms accounted for 39.7% of symptomatic burden. 55.4% of the symptoms were reported as an initial symptom, with neck pain the most common (13.5%). Non-conventional symptoms accounted for 11.1% of initial symptoms. 79.5% of the respondents were diagnosed late (>6 months). Heavy legs was the only initial symptom associated with early diagnosis. Conclusions A comprehensive description of the self-reported effects of DCM has been established, including the prevalence of symptoms at disease presentation. The experience of DCM is broader than suggested by conventional descriptions and further exploration of non-conventional symptoms may support earlier diagnosis.

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Mielopatía cervical degenerativa: una patología cada vez más frecuente y que requiere diagnóstico y manejo precoz

2022 , YURAC BARRIENTOS, RATKO JOVAN , José Manuel Matamala , ZAMORANO PÉREZ, JUAN JOSÉ , James S. Harrop , Benjamin M. Davies , Aria Nouri , Michael G. Fehlings

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Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey

2023 , Jamie F. M. Brannigan , Benjamin M. Davies , Oliver D. Mowforth , YURAC BARRIENTOS, RATKO JOVAN , Vishal Kumar , Joost Dejaegher , ZAMORANO PÉREZ, JUAN JOSÉ , Rory K. J. Murphy , Manjul Tripathi , David B. Anderson , James Harrop , Granit Molliqaj , Guy Wynne-Jones , Jose Joefrey F. Arbatin , So Kato , Manabu Ito , Jefferson Wilson , Ronie Romelean , Nicolas Dea , Daniel Graves , Enrico Tessitore , Allan R. Martin , Aria Nouri

Abstract Study design Cross-sectional survey. Objective Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. Methods Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. Results A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. Conclusions Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

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