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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2023 2023 0.0 0.0 0.5 0.5 1.0 1.0 1.5 1.5 2.0 2.0 2.5 2.5 3.0 3.0

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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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The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

2023 , Zhilin Jiang , Benjamin Davies , Carl Zipser , Konstantinos Margetis , Allan Martin , Stavros Matsoukas , Freschta Zipser-Mohammadzada , Najmeh Kheram , Andrea Boraschi , Elina Zakin , Oke Righteous Obadaseraye , Michael G. Fehlings , Jamie Wilson , YURAC BARRIENTOS, RATKO JOVAN , Chad E Cook , Jamie Milligan , Julia Tabrah , Shirley Widdop , Lianne Wood , Elizabeth A. Roberts , Tanzil Rujeedawa , Lindsay Tetreault

Study Design Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. Objectives This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? Methods A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. Results This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. Conclusion The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.

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The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review

2023 , Zhilin Jiang , Benjamin Davies , Carl Zipser , Konstantinos Margetis , Allan Martin , Stavros Matsoukas , Freschta Zipser-Mohammadzada , Najmeh Kheram , Andrea Boraschi , Elina Zakin , Oke Righteous Obadaseraye , Michael G. Fehlings , Jamie Wilson , YURAC BARRIENTOS, RATKO JOVAN , Chad E. Cook , Jamie Milligan , Julia Tabrah , Shirley Widdop , Lianne Wood , Elizabeth A. Roberts , Tanzil Rujeedawa , Lindsay Tetreault

Study Design Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. Objectives This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? Methods A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. Results This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). Conclusion Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.

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