Poster Presentation Sydney Spinal Symposium 2024

Variability and commonalities in diagnostic practices & surgical threshold for degenerative cervical myelopathy amongst surgical professionals in Australasia (#24)

Rohil Chauhan 1 2 , Anand Segar 1 3 4 , Nashwa Najib 5 , Ashish Diwan 5 , Steven White 2
  1. Auckland Spine Surgery Centre, Auckland, New Zealand
  2. Department of Physiotherapy, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
  3. Orthopaedics, Auckland City Hospital, Auckland, New Zealand
  4. Faculty of Medical and Health Sciences, Surgery, The University of Auckland, Auckland, New Zealand
  5. Spine Service, St George and Sutherland Clinical School at University of New South Wales, Kogarah, NSW, Australia

Introduction
Degenerative cervical myelopathy (DCM) is increasingly prevalent, posing diagnostic challenges due to symptom overlap with aging and deconditioning. Delayed diagnosis leads to poor outcomes, necessitating clear diagnostic criteria and early recognition. Understanding the diagnostic criteria used by Australasian orthopaedic spinal surgeons and neurosurgeons can help develop consensus-based criteria for primary care, where awareness is low. We conducted a survey to elicit perceived bases for diagnosis and surgical thresholds for DCM.

Methods

A 13-question survey consisting of checkbox and ranking questions on diagnostic signs, symptoms, and features warranting expedited surgical intervention was administered to Australasian orthopaedic spine surgeons and neurosurgeons via member associations. Ethical approval was granted by AUTEC (23/351).

Results

Sixty-two surgeons completed the survey (New Zealand 54.8%, Australia 45.2%), representing a 10% response rate. Respondents had an average post-fellowship experience of 16.3 years (SD=7.8), with an average monthly caseload of 2.8 DCM patients (SD=2.4). 46.5% of patients (SD=27.5) were considered surgical candidates upon initial consultation, indicating a notable clinical severity.

Key diagnostic symptoms included gait clumsiness (selected by 88.7%), hand dexterity decline (83.9%), hand clumsiness (74.2%), and hand numbness/paraesthesia (54.8%). Diagnostic signs included Hofmann sign (71.0%), hyperreflexia (69.4%), clonus (66.1%) and inability to tandem gait (56.5%).

CT and X-ray imaging were utilised by 67.7% and 64.5% of respondents respectively, alongside cervical spine MRI.

Symptoms most influencing surgical urgency were hand dexterity decline (selected by 71.0%), hand clumsiness (58.1%), history of falls (46.8%), and autonomic dysfunction (40.3%). Signs influencing surgical urgency were inability to tandem gait (59.7%), clonus (53.2%), hyperreflexia (51.6%), and Hofmann sign (37.1%).

Conclusions

This study highlights that while DCM symptoms for diagnosis, such as hand dexterity decline and hand and gait clumsiness, were most commonly selected, clinical signs used for diagnosis showed significant variability. Both symptoms and signs exhibited high variability when determining surgical thresholds. This variability in diagnostic criteria highlights the need for further research to establish consensus-based criteria for early recognition in primary care.