gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Disease severity does not reduce time to neurosurgical assessment in degenerative cervical myelopathy

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  • Bryn Hilton - University of Cambridge, Department of Clinical Neurosciences, Academic Neurosurgery Unit, Cambridge, United Kingdom
  • Benjamin Davies - University of Cambridge, Department of Clinical Neurosciences, Academic Neurosurgery Unit, Cambridge, United Kingdom
  • Alexander Komashie - University of Cambridge, Department of Engineering, Engineering Design Centre, Cambridge, United Kingdom
  • Mark Kotter - University of Cambridge, Department of Clinical Neurosciences, Academic Neurosurgery Unit, Cambridge, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.15.01

doi: 10.3205/17dgnc462, urn:nbn:de:0183-17dgnc4622

Published: June 9, 2017

© 2017 Hilton et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Degenerative cervical myelopathy (DCM) is spinal cord compression due to degenerative changes in the surrounding spine. DCM causes progressive spinal cord damage which can be arrested by surgical decompression. This study examines DCM patient flow through a healthcare system.

Methods: A retrospective cohort of 12 cases of DCM. Patients were identified by screening 3 months of cervical MRI scans at a tertiary neurosciences centre. Electronic records were used to document patient interactions (e.g. investigations or consultations) and disease severity (by inferring their modified Japanese Orthopaedic Assessment score based on documented findings) with respect to time since disease onset. Analysis was performed using linear regression and Chi-Squared tests. Averages expressed as medians ± interquartile range.

Results: Disease severity increased from 16±1.5 at primary care referral to 15±3.75 at neurosurgical assessment. Time from symptom onset to MRI scan was 8.6±7.7 months and a further 3±3 months to neurosurgical assessment. DCM progressed between MRI scan and neurosurgical assessment (-0.5±1.75). Disease severity did not correlate with referral times; from primary to secondary care (R2=0.03, p=0.65) or MRI scan to neurosurgical assessment (R2=0.06, p=0.48).

Conclusion: Delays in diagnosis and specialist assessment of DCM exist, even amongst the more severely affected patients. Patients with proven cord compression deteriorated waiting to see a spinal surgeon. A larger scale multivariate model is required to identify components of the healthcare system which influence management to optimise the patient pathway and improve outcomes