Identifying the initial symptoms to degenerative cervical myelopathy

1. The most commonly self-reported symptoms of degenerative cervical myelopathy (DCM) include poor balance, clumsiness, neck stiffness, impaired grip strength, and hand numbness.

2. The most commonly self-reported initial symptoms of DCM include neck pain, shoulder pain, hand parasthesias, arm pain, and Lhermitte’s phenomenon.

Evidence Rating Level: 3 (Average)

Degenerative cervical myelopathy (DCM) is a progressively debilitating condition involving degeneration in structures compressing the cervical spinal cord. While surgical decompression can halt progression and offer recovery, the prognosis depends on the extent of damage, where treatment within 6 months is associated with better outcomes. DCM is associated with long time to diagnosis, 2-5 years on average, likely due to poor awareness of the disease. Therefore, this survey study aimed to identify commonly patient-reported symptoms of DCM that may be applied to improve early diagnosis of DCM. This survey listed 56 DCM symptoms identified through semi-structured interviews of patients and caregivers, and was disseminated through an international charity website for DCM patients, myelopathy.org. Respondents were asked to identify current symptoms and the first symptom they recall experiencing with the disease. In total, there were 78 respondents to the survey. The most common symptoms included imbalance (84.2%), clumsiness (80.7%), neck stiffness (78.4%), poor grip strength (76.6%), and numbness in the hands (75.4%). The most common initial symptoms were neck pain (13.5%), shoulder pain (8.8%), hand parasthesias (7.0%), arm pain (5.3%), and Lhermitte’s phenomenon (5.3%) – a transient electric shock down the spine and extremities occurring with neck flexion. No one symptom was individually associated with early or late diagnosis. Overall, this study elucidated the most common patient-reported symptoms of DCM, including the commonly presenting initial symptoms.

Click to read the study in PLOS

Image: PD

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