Abstract
ObjectivesDegenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyper-reflexia, focal weakness, and sensory impairment. DCM can cause progressive loss of manual dexterity, reduced upper limb (UL) function and disability. The purpose of this study was to define relationships between impairment and disability of the UL and determine the impact of duration of symptoms on disease severity.DesignAn observational cross-sectional study quantifying disease severity, UL impairment and disability at time of diagnosis was conducted. A second observational longitudinal cohort was studied at the time of diagnosis and 1 year later.SettingToronto Western Hospital, Spine Program.SubjectsThe cross sectional study included 140 study subjects diagnosed with mild, moderate or severe DCM. For the longitudinal study, 61 study subjects with mild DCM were enrolled and split into two groups, one group with less than 12 months of symptom duration and more than 12 months.Main measuresModified Japanese Orthopaedic Assessment (mJOA); Graded Redefined Assessment of Sensation, Strength and Prehension (GRASSP); Quick Disability of the Arm, Shoulder and Hand (QuickDASH).ResultsPearson correlation coefficients between GRASSP and QuickDASH revealed significant relationships between strength, sensation and dexterity for all patients to varying degrees. The covariate (mJOA) was significantly related to QuickDASH, indicating duration of symptoms has an important effect on UL disability in the mild severity group.ConclusionsStrength, sensation and dexterity play a defining role in disability of the UL across all severities of DCM and are discriminant measures. Duration of symptoms has a significant impact on self-perceived disability, where a longer duration in mild patients results in diminished disability, suggesting adaptation. Duration of symptoms is an important factor to consider in the treatment plan for patients with mild disease.
Highlights
Degenerative Cervical Myelopathy (DCM) encompasses the chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative spinal pathologies
The covariate was significantly related to QuickDASH, indicating duration of symptoms has an important effect on upper limb (UL) disability in the mild severity group
Duration of symptoms has a significant impact on self-perceived disability, where a longer duration in mild patients results in diminished disability, suggesting adaptation
Summary
Degenerative Cervical Myelopathy (DCM) encompasses the chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative spinal pathologies. It is the most common form of spinal cord impairment and can cause functional decline leading to reduced independence and quality of life [1,2,3,4]; with a main consequence being loss of manual dexterity related to reduced upper limb (UL) function and disability. Patients with moderate or severe presentation of DCM are offered surgical decompression, which often results in improved functional status [5,6]. A period of watchful waiting and nonoperative management is the current standard of care [8]
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