Podium 20
Tracks
Breakout 3
| Sunday, September 8, 2024 |
| 11:15 AM - 11:45 AM |
| Dobson 3 |
Speaker
Mr Rohil Chauhan
Orthopaedic Physiotherapy Clinician
Auckland Spine Surgery Centre
Diagnostic Criteria and Surgical Thresholds for Degenerative Cervical Myelopathy: Survey of New Zealand Spine Surgeons
Presentation Abstract
Background
The recognition of diagnostic features of degenerative cervical myelopathy (DCM) amongst New Zealand (NZ) primary care clinicians is highly varied. Early recognition is key for DCM, as delayed diagnosis leads to poor outcomes. Thus, understanding NZ spine surgeons' diagnostic criteria would be a useful step toward the development of consensus-based criteria.
Purpose
To explore DCM diagnostic criteria and key signs warranting expeditious surgical management, utilised by NZ spine surgeons.
Methods
A cross-sectional survey was conducted to gather anonymized responses from NZ-based spine surgeons. The questionnaire was piloted, and ethical approval granted by AUTEC (23/351) before dissemination via the NZ spine society.
Results
Thirty-seven respondents, constituting a 56% response rate, participated in the survey. The mean post-fellowship experience was 14.2 years (SD: 8.52), with an average monthly caseload of 1.83 DCM patients (SD: 1.22). Approximately 50% of patients (SD: 35.1) are surgical candidates upon initial consultation, indicating a notable clinical severity.
Key symptoms diagnostic of DCM included gait clumsiness (reported by 84% of respondents), hand dexterity decline (78%), hand clumsiness (65%), and hand numbness/paraesthesia (46%). The most diagnostic signs included clonus (62%), Hoffmann (62%), inability to tandem gait (60%), and hyperreflexia (60%).
Symptoms with the most influence on surgical urgency were hand dexterity decline (reported by 70%), hand clumsiness (49%), history of falls (41%), and autonomic dysfunction (32%). Key signs contributing to surgical urgency included inability to tandem gait (62%), hyperreflexia (51%), clonus (41%), and positive Romberg's (24%).
Conclusion
The survey reveals key clinical features aiding DCM diagnosis and surgical decision-making. Further consensus-based processes will be undertaken to create clinical criteria to improve DCM recognition and referral in primary care.
Implications
Gait clumsiness and hand dexterity decline were identified as key DCM symptoms, although clinical signs for diagnostic and surgical workup received more varied responses, yet to be agreed upon.
The recognition of diagnostic features of degenerative cervical myelopathy (DCM) amongst New Zealand (NZ) primary care clinicians is highly varied. Early recognition is key for DCM, as delayed diagnosis leads to poor outcomes. Thus, understanding NZ spine surgeons' diagnostic criteria would be a useful step toward the development of consensus-based criteria.
Purpose
To explore DCM diagnostic criteria and key signs warranting expeditious surgical management, utilised by NZ spine surgeons.
Methods
A cross-sectional survey was conducted to gather anonymized responses from NZ-based spine surgeons. The questionnaire was piloted, and ethical approval granted by AUTEC (23/351) before dissemination via the NZ spine society.
Results
Thirty-seven respondents, constituting a 56% response rate, participated in the survey. The mean post-fellowship experience was 14.2 years (SD: 8.52), with an average monthly caseload of 1.83 DCM patients (SD: 1.22). Approximately 50% of patients (SD: 35.1) are surgical candidates upon initial consultation, indicating a notable clinical severity.
Key symptoms diagnostic of DCM included gait clumsiness (reported by 84% of respondents), hand dexterity decline (78%), hand clumsiness (65%), and hand numbness/paraesthesia (46%). The most diagnostic signs included clonus (62%), Hoffmann (62%), inability to tandem gait (60%), and hyperreflexia (60%).
Symptoms with the most influence on surgical urgency were hand dexterity decline (reported by 70%), hand clumsiness (49%), history of falls (41%), and autonomic dysfunction (32%). Key signs contributing to surgical urgency included inability to tandem gait (62%), hyperreflexia (51%), clonus (41%), and positive Romberg's (24%).
Conclusion
The survey reveals key clinical features aiding DCM diagnosis and surgical decision-making. Further consensus-based processes will be undertaken to create clinical criteria to improve DCM recognition and referral in primary care.
Implications
Gait clumsiness and hand dexterity decline were identified as key DCM symptoms, although clinical signs for diagnostic and surgical workup received more varied responses, yet to be agreed upon.
Biography
Rohil is an Auckland-based physiotherapist, working in an orthopaedic-triage role at the Auckland Spine Surgery Centre and in musculoskeletal private practice. He has a research interest in Degenerative Cervical Myelopathy (DCM), and is an invited member of 2 international DCM working groups: Perioperative Management and Professional Education for DCM. The latter aims to bridge knowledge gaps in DCM awareness and screening confidence amongst primary healthcare clinicians worldwide. Further, he is actively researching the current 'state of play' of DCM Assessment practices in Australasia and the validity of a novel MRI screening technique as part of his Masters thesis.
Mr Rohil Chauhan
Orthopaedic Physiotherapy Clinician
Auckland Spine Surgery Centre
Recognising the Underdiagnosed Prevalence of Degenerative Cervical Myelopathy - a single-centre audit
Presentation Abstract
Background
Degenerative cervical myelopathy (DCM) has a prevalence of 2.3% amongst adults, however this figure is thought to be underreported due to missed diagnosis. Current cervical screening guidelines, which have a strong emphasis on recognising vascular risk, overshadows the equally significant consideration of recognizing spinal cord dysfunction, as seen with DCM. Considering the patho-mechanics of DCM, and the potential for progressive neurofunctional decline, an understanding DCM and concomitant prevalence in common patient populations, such as lower back pain, is important when considering utilising cervical mobilisation and manipulation.
Purpose
This study aims to report on the prevalence of incidentally-identified community-dwelling DCM cases, emphasising the potential that DCM has an underreported prevalence, warranting clinical consideration.
Methods
A retrospective audit was conducted at a secondary care spine centre from January 2022 to December 2023. The study included consecutive patients over the age of 45 years, referred for lumbar spine-related issues as a convenient patient subset. All patients were screened for signs and symptoms of DCM by an orthopaedic-triage physiotherapist, and DCM was diagnosed upon the presence of at least one DCM symptom and one clinical sign coupled with MRI-confirmation.
Results
Out of 388 screened patients, 16 (4.1%) were diagnosed with DCM with an average age of 62.8 years; 11 of these patients were male. Ten out of 16 diagnosed patients were scheduled for surgical decompression.
Conclusion
This audit highlights the underrecognized prevalence of DCM in community-dwelling individuals. Further research to understand key at-risk patient populations will help identify relevant clinical populations where cervical manual therapy techniques may be contraindicated or reconsidered.
Implications
Despite the lack of recommendations for DCM screening in international pre-manipulative guidelines, the authors suggest considering screening patients over the age of 45 years for DCM prior to considering cervical spinal manipulation and high grade mobilisations.
Degenerative cervical myelopathy (DCM) has a prevalence of 2.3% amongst adults, however this figure is thought to be underreported due to missed diagnosis. Current cervical screening guidelines, which have a strong emphasis on recognising vascular risk, overshadows the equally significant consideration of recognizing spinal cord dysfunction, as seen with DCM. Considering the patho-mechanics of DCM, and the potential for progressive neurofunctional decline, an understanding DCM and concomitant prevalence in common patient populations, such as lower back pain, is important when considering utilising cervical mobilisation and manipulation.
Purpose
This study aims to report on the prevalence of incidentally-identified community-dwelling DCM cases, emphasising the potential that DCM has an underreported prevalence, warranting clinical consideration.
Methods
A retrospective audit was conducted at a secondary care spine centre from January 2022 to December 2023. The study included consecutive patients over the age of 45 years, referred for lumbar spine-related issues as a convenient patient subset. All patients were screened for signs and symptoms of DCM by an orthopaedic-triage physiotherapist, and DCM was diagnosed upon the presence of at least one DCM symptom and one clinical sign coupled with MRI-confirmation.
Results
Out of 388 screened patients, 16 (4.1%) were diagnosed with DCM with an average age of 62.8 years; 11 of these patients were male. Ten out of 16 diagnosed patients were scheduled for surgical decompression.
Conclusion
This audit highlights the underrecognized prevalence of DCM in community-dwelling individuals. Further research to understand key at-risk patient populations will help identify relevant clinical populations where cervical manual therapy techniques may be contraindicated or reconsidered.
Implications
Despite the lack of recommendations for DCM screening in international pre-manipulative guidelines, the authors suggest considering screening patients over the age of 45 years for DCM prior to considering cervical spinal manipulation and high grade mobilisations.
Biography
Rohil is an Auckland-based physiotherapist, working in an orthopaedic-triage role at the Auckland Spine Surgery Centre and in musculoskeletal private practice. He has a research interest in Degenerative Cervical Myelopathy (DCM), and is an invited member of 2 international DCM working groups: Perioperative Management and Professional Education for DCM. The latter aims to bridge knowledge gaps in DCM awareness and screening confidence amongst primary healthcare clinicians worldwide. Further, he is actively researching the current 'state of play' of DCM Assessment practices in Australasia and the validity of a novel MRI screening technique as part of his Masters thesis.
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