High Incidence of Undiagnosed Cervical Myelopathy in Patients With Hip Fracture Compared With Controls

Radcliff, Kris; Curry, Edward P.; Trimba, Roman; Walker, Jeffrey; Purtill, James J.; Austin, Matthew S.; Parvızı, Javad; Vaccaro, Alexander R.; Hilibrand, Alan S.; Albert, Todd J.

doi:10.1097/bot.0000000000000485

Cited by 33 publications

(21 citation statements)

References 31 publications

(34 reference statements)

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“…The notion that DCM is underdiagnosed is supported by a high incidence (18%) of unrecognized DCM in a small series of patients presenting with a neck of femur fracture. 63 Moreover, in the longest observational study of asymptomatic SCC Global Spine Journal by Bednarik et al, 6 the likelihood of developing DCM increased over time, with 8% developing DCM after 1 year and 22% with median follow-up of 44 months. 6,7 The high incidence of asymptomatic SCC reported in cross-sectional studies also indicates that the prevalence of DCM is higher than previously estimated.…”

Section: Discussionmentioning

confidence: 99%

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The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

Smith

Stewart

Davies

et al. 2020

Global Spine Journal

103

102

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Study Design: Systematic review and meta-analysis. Objectives: Cervical spinal cord compression (SCC) due to degenerative changes of the spine is a frequent finding on magnetic resonance imaging (MRI). While most people remain asymptomatic, a proportion develop symptoms of degenerative cervical myelopathy (DCM). DCM is an often-progressive neurological disease that can cause quadriplegia. The epidemiology of SCC and DCM is poorly understood. We sought to estimate the prevalence of degenerative cervical SCC and DCM from cross-sectional cohorts undergoing MRI. Methods: We conducted a systematic review and meta-analysis of MRI reports on human subjects older than 16 years with degenerative SCC. A predetermined search strategy was used to identify relevant literature on MEDLINE. Title and abstract screenings were followed by full text screening. Data was extracted and analyzed by fixed or random-effects models. Results: The present search returned 1506 publications. Following our exclusion criteria, 19 studies were included. Subgroup analysis of 3786 individuals estimated the prevalence of asymptomatic SCC in a healthy population as 24.2% with a significantly higher prevalence of SCC in older populations compared with younger populations and American/European populations compared with Asian populations. Subgroup analysis of 1202 individuals estimated the prevalence of DCM in a healthy population as 2.3%. Conclusions: We present the first estimates of the prevalence of asymptomatic SCC and DCM. Studies investigating the epidemiology of SCC are heterogeneous in methodology and results. These data indicate the need for more studies into the epidemiology of SCC and DCM performed with consistent methodologies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

Smith

Stewart

Davies

et al. 2020

Global Spine Journal

103

102

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“…Many patients with DCM remain undiagnosed. A small study in 66 patients with hip fracture found 18% of patients who were previously undiagnosed to have clinical findings suggestive of DCM 8 …”

Section: What Is Degenerative Cervical Myelopathy?mentioning

confidence: 99%

Degenerative cervical myelopathy

Davies

Mowforth

Smith

et al. 2018

BMJ

221

223

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“…It is common with a prevalence of up to 5% in the over 40s,1 which is expected to rise as populations age 4 5. However, most patients never get a diagnosis,6 7 and those that do face long diagnostic delays, often with initial misdiagnosis 2. This is significant given that surgery is the only currently-effective treatment but cannot reverse existing damage 3 8 9…”

Section: Discussionmentioning

confidence: 99%

“I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy

Mowforth

Davies

Kotter³

2019

BMJ Case Rep

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Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction, most classically presenting with a broad-based gait and clumsy hands. Limb sensory loss and paraesthesia are considered common symptoms of DCM. However, we report an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturising cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.

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High Incidence of Undiagnosed Cervical Myelopathy in Patients With Hip Fracture Compared With Controls

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 33 publications

References 31 publications

The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

Degenerative cervical myelopathy

“I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy

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