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

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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Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE DCM Research Priority Number 9]

Global Spine Journal ◽

10.1177/21925682211057484 ◽

2021 ◽

pp. 219256822110574

Author(s):

Allan R. Martin ◽

Lindsay Tetreault ◽

Benjamin M. Davies ◽

Armin Curt ◽

Patrick Freund ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Myelopathy ◽

Tissue Injury ◽

Quantitative Imaging ◽

Cord Compression ◽

Narrative Review ◽

Imaging Tool ◽

Spinal Cord Dysfunction ◽

Degenerative Cervical Myelopathy ◽

And Function

Study Design Narrative review. Objective The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. Methods A narrative review was conducted to summarize the existing literature and highlight future directions. Results Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. Conclusion Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.

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Genetics of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis of Candidate Gene Studies

Journal of Clinical Medicine ◽

10.3390/jcm9010282 ◽

2020 ◽

Vol 9 (1) ◽

pp. 282 ◽

Cited By ~ 1

Author(s):

Daniel H. Pope ◽

Benjamin M. Davies ◽

Oliver D. Mowforth ◽

A. Ramsay Bowden ◽

Mark R. N. Kotter

Keyword(s):

Spinal Cord ◽

Cervical Myelopathy ◽

Surgical Intervention ◽

Meta Analysis ◽

Spinal Column ◽

Clinical Severity ◽

Spinal Cord Disease ◽

Clinical Onset ◽

Adult Spinal Cord ◽

Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is estimated to be the most common cause of adult spinal cord impairment. Evidence that is suggestive of a genetic basis to DCM has been increasing over the last decade. A systematic search was conducted in MEDLINE, EMBASE, Cochrane, and HuGENet databases from their origin up to 14th December 2019 to evaluate the role of single genes in DCM in its onset, clinical phenotype, and response to surgical intervention. The initial search yielded 914 articles, with 39 articles being identified as eligible after screening. We distinguish between those contributing to spinal column deterioration and those contributing to spinal cord deterioration in assessing the evidence of genetic contributions to DCM. Evidence regarding a total of 28 candidate genes was identified. Of these, 22 were found to have an effect on the radiological onset of spinal column disease, while 12 genes had an effect on clinical onset of spinal cord disease. Polymorphisms of eight genes were found to have an effect on the radiological severity of DCM, while three genes had an effect on clinical severity. Polymorphisms of six genes were found to have an effect on clinical response to surgery in spinal cord disease. There are clear genetic effects on the development of spinal pathology, the central nervous system (CNS) response to bony pathology, the severity of both bony and cord pathology, and the subsequent response to surgical intervention. Work to disentangle the mechanisms by which the genes that are reviewed here exert their effects, as well as improved quality of evidence across diverse populations is required for further investigating the genetic contribution to DCM.

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Quantitative analysis of medical students’ and physicians’ knowledge of degenerative cervical myelopathy

BMJ Open ◽

10.1136/bmjopen-2018-028455 ◽

2020 ◽

Vol 10 (1) ◽

pp. e028455 ◽

Cited By ~ 2

Author(s):

Mueez Waqar ◽

Jane Wilcock ◽

Jayne Garner ◽

Benjamin Davies ◽

Mark Kotter

Keyword(s):

Medical Students ◽

Cervical Myelopathy ◽

Gap Analysis ◽

Cauda Equina ◽

Textbook Analysis ◽

Secondary Outcome ◽

Common Disease ◽

Education Gap ◽

Degenerative Cervical Myelopathy ◽

Gp Training

ObjectivesWe have previously identified a delay in general practitioner (GP) referrals for patients with degenerative cervical myelopathy (DCM). The aim of this study was to evaluate whether an education gap existed for DCM along the GP training pathway by quantitatively assessing training in, and knowledge of, this condition.DesignGap analysis: comparison of DCM to other conditions. Comparators selected on the basis of similar presentation/epidemiology (multiple sclerosis), an important spinal emergency (cauda equina syndrome) and a common disease (diabetes mellitus).SubjectsMedical students, foundation doctors and GP trainees.Primary and secondary outcome measures(1) Assessment of training: quantitative comparison of references to DCM in curricula (undergraduate/postgraduate) and commonly used textbooks (Oxford Handbook Series), to other conditions using modal ranks. (2) Assessment of knowledge: using standardised questions placed in an online question-bank (Passmedicine). Results were presented relative to the question-bank mean (+/−).ResultsDCM had the lowest modal rank of references to the condition in curricula analysis and second lowest modal rank in textbook analysis. In knowledge analysis questions were attempted 127 457 times. Performance for DCM questions in themes of presentation (+6.1%), workup (+0.1%) and management (+1.8%) were all greater than the question-bank mean and within one SD. For students and junior trainees, there was a serial decrease in performance from presentation and workup (−0.7% to +10.4% relative to question-bank mean) and management (−0.6% to −3.9% relative to question-bank mean).ConclusionsAlthough infrequently cited in curricula and learning resources, knowledge relating to DCM was above average. However, knowledge relating to its management was relatively poor.

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First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

European Spine Journal ◽

10.1007/s00586-021-07060-3 ◽

2021 ◽

Author(s):

Neriman Özkan ◽

Mehdi Chihi ◽

Tobias Schoemberg ◽

Thiemo Florin Dinger ◽

Moritz Helsper ◽

...

Keyword(s):

Cervical Myelopathy ◽

Neurological Outcome ◽

Postoperative Outcome ◽

Gait Disturbance ◽

Motor Deficits ◽

Japanese Orthopedic Association ◽

Spinal Cord Dysfunction ◽

Degenerative Cervical Myelopathy ◽

Gait Disturbances ◽

The Relationship

Abstract Purpose Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. Methods A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. Results In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. Conclusion Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.

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An Imported Case of Echinococcosis in a Pregnant Lady with Unusual Presentation

Case Reports in Infectious Diseases ◽

10.1155/2013/753848 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ahmed Al-Ani ◽

Abdul-Naser Elzouki ◽

Rashid Mazhar

Keyword(s):

Bronchial Asthma ◽

Unusual Case ◽

Left Lung ◽

Common Disease ◽

Shortness Of Breath ◽

Hydatid Cysts ◽

Imported Case ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

One Year

A 31-year-old Syrian pregnant (25-week duration) patient who was managed as a case of bronchial asthma for one year because of chronic cough and progressive breathlessness presented to the Accident and Emergency Department at Hamad General Hospital, Doha, with cough and shortness of breath. On the day of admission, she coughed large amount of yellowish watery material which was salty and sour in taste. She was found by radiological investigations to have multiple giant hydatid cysts (three in the lungs and one in the liver), with ruptured cyst in the left lung. We report here an unusual case of giant multiple pulmonary hydatidosis localized in the lungs and masquerading as bronchial asthma in a pregnant lady. The case represents an uncommon situation of a common disease of rupture of hydatid cyst of the lung in a pregnant lady in her 3rd trimester.

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Spine Treatment Appraisal Report (STAR): Does Riluzole Improve Outcomes in Patients Undergoing Decompression Surgery for Degenerative Cervical Myelopathy?

Global Spine Journal ◽

10.1177/2192568221997401 ◽

2021 ◽

pp. 219256822199740

Author(s):

Joseph R. Dettori

Keyword(s):

Cervical Myelopathy ◽

Decompressive Surgery ◽

Decompression Surgery ◽

Phase 3 ◽

Double Blind ◽

Safety And Efficacy ◽

Double Blind Placebo ◽

Degenerative Cervical Myelopathy

Fehlings MG, Badhiwala JH, Ahn H, et al. Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol. 2020.

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Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms

Journal of Clinical Medicine ◽

10.3390/jcm10061214 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1214

Author(s):

Ji Tu ◽

Jose Vargas Castillo ◽

Abhirup Das ◽

Ashish D. Diwan

Keyword(s):

Cervical Myelopathy ◽

Molecular Mechanisms ◽

Current Knowledge ◽

Imaging Techniques ◽

Disease Process ◽

Classification Systems ◽

Molecular Features ◽

Formidable Challenge ◽

Long Term Treatment ◽

Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.

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Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy

Health Information & Libraries Journal ◽

10.1111/hir.12373 ◽

2021 ◽

Author(s):

Maaz A. Khan ◽

Oliver M. Mowforth ◽

Isla Kuhn ◽

Mark R. N. Kotter ◽

Benjamin M. Davies

Keyword(s):

Cervical Myelopathy ◽

Search Filter ◽

Degenerative Cervical Myelopathy

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Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

Global Spine Journal ◽

10.1177/2192568221998306 ◽

2021 ◽

pp. 219256822199830

Author(s):

Mohamed Kamal Mesregah ◽

Blake Formanek ◽

John C. Liu ◽

Zorica Buser ◽

Jeffrey C. Wang

Keyword(s):

Propensity Score ◽

Cervical Myelopathy ◽

Perioperative Complications ◽

International Classification Of Diseases ◽

Significance Level ◽

Chi Squared ◽

Retrospective Comparative Study ◽

Posterior Laminectomy ◽

Degenerative Cervical Myelopathy ◽

New Onset

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

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