Diagnostic Delays Lead to Greater Disability in Degenerative Cervical Myelopathy and Represent a Health Inequality

Abstract

Study Design. Online survey. Objective. This study seeks to quantify delays faced, determine demographics of patients most likely to face delay, and determine whether delays affect surgical management and outcomes. Summary of Background Data. Patients report significant delays in diagnosis of degenerative cervical myelopathy (DCM). Methods. Seven hundred seventy-eighty patients with self-reported DCM recruited via online survey hosted on myelopathy.org. A cumulative odds ordinal logistic regression was run to determine the effects of demographic (sex, country of residence, ethnicity, household income, and educational status) on the delay in diagnosis of DCM. Chi-square tests of homogeneity were run to determine the effects of delayed diagnosis on functional outcomes (patient-derived modified Japanese Orthopaedic Association disability score, support dependence, and employment status) and surgical management (anterior/posterior approach, single-/multilevel surgery). A Kruskal-Wallis H test was used to determine whether delayed diagnosis affected the number of operations undergone. Results. The average delay in diagnosis faced was “1–2 years." Greater delays in diagnosis were faced by Black or African American patients (P = 0.010). Delayed diagnosis was predictive of greater disability as assessed by patient-derived modified Japanese Orthopaedic Association score (P = 0.001), support dependence (P = 0.040), and employment status (P < 0.0005). Delayed diagnosis did not affect the likelihood of surgery, the number of operations undergone or perioperative characteristics. Conclusion. Patients continue to face significant delays in diagnosis of DCM. Ethnicity significantly influences length of delay experienced. Longer delays do not appear to affect surgical management but are associated with greater disability. Level of Evidence: 3

Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions

“…This has proved a challenge for literature synthesis [9] and has consequently hindered many important lines of investigation, including the evaluation of prevalence rates for specific phenotypes, risk factors for disease development, the natural history, and surgical decision-making. It is also possible that the inconsistent and complex terminology has contributed to a lack of disease awareness [10], which has been considered to be a contributing factor to diagnostic delay and disability [11].…”

Preoperative Neck Disability Severity Limits Extent of Postoperative Improvement Following Cervical Spine Procedures

“…Prior analyses have established that preoperative disability may be a predictor for postoperative outcomes in myelopathy patients by using the JOA and mJOA. 11,12 Goh et al 13 further stratified severity by JOA scores to demonstrate that severe preoperative myelopathy patients reported greater postoperative improvement and ability to attain a minimum clinically important difference (MCID) in functional and mental health outcomes following surgery. Though not categorized by severity, there has been a report of higher baseline JOA scores significantly reducing the odds of achieving MCID in myelopathy patients as well.…”

Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy

“…The balance parameters showed higher correlation coefficients with the tandem gait grades and the Nurick scale grades than the JOA sub-scores. Because the 10-step tandem gait is easy to practice and the severity of the gait disabilities can be objectively differentiated between the grades, we believe that this 10-step tandem gait test would be an important screening test for the patients that have mild gait or balance problems, but feel like there is nothing wrong with their walking 24 . Furthermore, this test can be used for longitudinal monitoring for patients who have performed treatment for cervical myelopathy.…”