Introduction
Degenerative Cervical Myelopathy (DCM) has been incidentally found in 10-18% of patients assessed for non-cervical spinal conditions and hip fractures in tertiary care. However, the true prevalence of DCM is likely underreported. Whole spine sagittal MRI (WSSMRI) series has shown potential in identifying incidental spinal cord compression. This retrospective audit examines the prevalence of DCM in patients with non-cervical conditions at an orthopedic spine centre using WSSMRI.
Methods
A retrospective audit was conducted at a secondary care orthopedic spine centre from January 2022 to December 2023. Patients over 45 years, referred for non-cervical spine-related issues, were included. Routine assessment for DCM signs and symptoms was performed alongside evaluation of their presenting condition. Provisional DCM diagnosis was based on one clinical sign and symptom, along with central cord compression and cerebrospinal fluid effacement on T2-weighted WSSMRI. Confirmatory diagnosis required a dedicated cervical spine MRI.
Results
Out of 388 patients screened, 21 were provisionally diagnosed with DCM (prevalence of 5.41%), using the aforementioned criteria.
Dedicated cervical spine MRI confirmed 14 DCM cases (prevalence of 3.6%), refuted 3 cases, and 4 patients were lost to follow-up. Among the 14 confirmed cases, 11 were scheduled for surgery, 7 had multi-level involvement (>1 involved level), and 6 had T2-cord signal hyperintensity. The mean age of the 14 patients was 62.8 years, with a majority being male (10/14).
Conclusion
DCM is reported to have a prevalence of 5% in adults over 45 years. This study found a prevalence of 3.6% in patients with non-cervical conditions, suggesting the true community prevalence may be underreported. Routine screening of WSSMRI alongside clinical screening in this population may aid early identification of DCM, though further studies are needed to determine its diagnostic accuracy.