Symptoms of Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (formerly known as cervical spondylotic myelopathy) can be a debilitating and consequential condition that we must be on the look out for as chiropractors, especially in our aging patients…this week, a summary of a study outlining the symptoms we should be on the lookout for.

Degenerative cervical myelopathy (DCM) is a progressive spinal condition and the most common cause of spinal cord impairment worldwide. DCM is underrepresented in medical school and postgraduate programs, often leading to delayed diagnosis in patients presenting to their primary care provider. The delay in patients receiving appropriate care could have consequential negative effects on neurological and functional recovery following surgery as myelopathy severity, duration of symptoms and gait dysfunction are significant predictors of worse surgical outcomes, making early detection a priority.

Misdiagnosis or delayed diagnosis of DCM is likely due to the variety of clinical presentations, incomplete neurological examinations by clinicians and reduced awareness of this condition. Patients present with a wide range of sensory and motor complaints in their upper and lower extremities, as well as autonomic dysfunction. Given that there is no single clinical feature or test that is sufficient to diagnose DCM, developing diagnostic criteria for this condition would be valuable. Diagnostic criteria for DCM could improve patient care by facilitating earlier diagnosis and treatment, as well as act as a reference for primary care physicians, allied health professionals and other specialists who encounter these patients. The first step is to determine variables that should be included in the diagnostic criteria.

The objective of this study is to conduct a scoping review of the literature to determine what is the diagnostic accuracy of clinical symptoms of DCM and what is the frequency of these clinical symptoms.

From Dr. Thistle:

DCM can be a condition that escapes the radar of even the best clinicians, often because of the gradual onset of these symptoms. In neck pain patients that you see over several years, this condition should be on your mind as they age and perhaps experience new symptoms or progressive neck pain (think of patients that mention things like: “…doc, my fingers feel numb”, “…doc, I’ve been clumsy lately”). Be sure to treat all your patients as a ‘new patient’ occasionally, especially in the presence of emerging symptoms they haven’t experienced before. A careful neurological examination can tell you a lot about their status over time, so these tests are worth repeating and carefully documenting over time. In the case of DCM, early referral is crucial to optimize outcomes, and chiropractors and other allied health professionals can assist in this process.

This week’s Research Review: “Symptoms of Degenerative Cervical Myelopathy“

This paper was published in the Global Spine Journal (2024)

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