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dc.contributor.authorHilton, Bryn
dc.contributor.authorTempest-Mitchell, Jennifer
dc.contributor.authorDavies, Benjamin
dc.contributor.authorKotter, Mark
dc.date.accessioned2019-01-03T00:30:09Z
dc.date.available2019-01-03T00:30:09Z
dc.date.issued2018
dc.identifier.issn1932-6203
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/287481
dc.description.abstractINTRODUCTION: Degenerative Cervical Myelopathy [DCM] often presents with non-specific symptoms and signs. It progresses insidiously and leads to permanent neurological dysfunction. Decompressive surgery can halt disease progression, however significant delays in diagnosis result in increased disability and limit recovery. The nature of early DCM symptoms is unknown, moreover it has been suggested incomplete examination contributes to missed diagnosis. This study examines how DCM is currently assessed, if assessment differs between stages of healthcare, and whether this influences patient management. STUDY DESIGN: Retrospective cohort study. METHODS: Cervical MRI scans (N = 1123) at a tertiary neurosciences center, over a single year, were screened for patients with DCM (N = 43). Signs, symptoms, and disease severity of DCM were extracted from patient records. Patients were considered at 3 phases of clinical assessment: primary care, secondary care, and surgical assessment. RESULTS: Upper limb paraesthesia and urinary dysfunction were consistently the most and least prevalent symptoms respectively. Differences between assessing clinicians were present in the reporting of: limb pain (p<0.005), objective limb weakness (p = 0.01), hyperreflexia (p<0.005), Hoffmann reflex (p<0.005), extensor plantar reflex (p = 0.007), and lower limb spasticity (p<0.005). Pathological reflexes were least frequently assessed by primary care doctors. CONCLUSION: DCM assessment varies significantly between assessors. Reporting of key features of DCM is especially low in primary care. Incomplete assessment may hinder early diagnosis and referral to spinal surgery.
dc.format.mediumElectronic-eCollection
dc.languageeng
dc.publisherPublic Library of Science (PLoS)
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCervical Vertebrae
dc.subjectHumans
dc.subjectSpinal Cord Compression
dc.subjectNeurodegenerative Diseases
dc.subjectMagnetic Resonance Imaging
dc.subjectTreatment Outcome
dc.subjectCohort Studies
dc.subjectNeurosurgery
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectInfant, Newborn
dc.subjectFemale
dc.subjectMale
dc.subjectYoung Adult
dc.subjectSpecialization
dc.subjectDelayed Diagnosis
dc.titleAssessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes.
dc.typeArticle
prism.issueIdentifier12
prism.publicationDate2018
prism.publicationNamePLoS One
prism.startingPagee0207709
prism.volume13
dc.identifier.doi10.17863/CAM.34787
dcterms.dateAccepted2018-11-03
rioxxterms.versionofrecord10.1371/journal.pone.0207709
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-01
dc.contributor.orcidHilton, Bryn [0000-0001-9617-6753]
dc.contributor.orcidTempest-Mitchell, Jennifer [0000-0002-3990-140X]
dc.contributor.orcidDavies, Benjamin [0000-0003-0591-5069]
dc.contributor.orcidKotter, Mark [0000-0001-5145-7199]
dc.identifier.eissn1932-6203
rioxxterms.typeJournal Article/Review
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (CS-2015-15-023)
cam.issuedOnline2018-12-17


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International