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degenerative cervical myelopathy

Degenerative Cervical Myelopathy: Navigating Management in the Primary Care Setting

Teaser: 

Karlo M. Pedro, MD,1 James Milligan, MD,2 Michael G. Fehlings, MD, PhD,3

1 Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
2 McMaster University, Department of Family Medicine, Hamilton, ON, Canada.
3Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.

CLINICAL TOOLS

Abstract: Degenerative cervical myelopathy (DCM) is a progressive and acquired spinal disorder that represents a potentially reversible cause of spinal cord impairment among adults. It remains underdiagnosed due to a low level of awareness amongst the public and healthcare professionals. Diagnosis is anchored on high clinical suspicion after a thorough history and physical examination and confirmed using magnetic resonance (MR) imaging of the cervical spine. Improving early diagnosis and ensuring timely surgical intervention are crucial in preventing long-term disability and optimizing long-term outcomes for DCM patients.
Key Words:degenerative cervical myelopathy, myelopathy, non-traumatic spinal cord injury, primary care.

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DCM is the most common cause of non-traumatic spinal cord dysfunction among adults worldwide
DCM is a potentially reversible disease with profound neurologic implications if left untreated
A thorough history and physical examination, supplemented with MR imaging of the cervical spine, are key elements to avoid misdiagnosis and delays in management
The hallmark signs of DCM are deterioration of hand motor function (eg. decreased coordination/clumsiness) as well as gait instability
MRI is the imaging of choice to confirm a diagnosis of DCM
Surgery is the only proven therapy that can halt the progression of DCM
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Primary Care Approach to Degenerative Cervical Myelopathy

Teaser: 

1Ali Moghaddamjou, MD,2Jetan H. Badhiwala, MD,3Michael G. Fehlings. MD, Phd, FRCSC, FACS,

1Division of Neurosurgery, Department of Surgery, University of Toronto, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 2Division of Neurosurgery, Department of Surgery, University of Toronto, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 3Division of Neurosurgery, Department of Surgery, University of Toronto, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

CLINICAL TOOLS

Abstract: Degenerative cervical myelopathy is an umbrella term describing all degenerative conditions that present with cervical myelopathy due to compression of the spinal cord. The role of primary care physicians (PCPs) in early identification is vital as delayed diagnosis can lead to irreversible neurological impairment. Patients often present with subtle neurological deficits associated with neck or upper extremity pain. Screening for upper motor neuron signs, gait disturbances, fine motor abnormalities and bowel bladder symptoms is critical. Currently, surgical decompression is the treatment of choice but with future advancements in non-operative treatments, PCPs are expected to play a larger role in treatment plans.
Key Words: degenerative cervical myelopathy, primary care, cervical spondylotic myelopathy, degenerative disc disease.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

PCPs play a vital role in the management of DCM as a delayed diagnosis can lead to irreversible neurological impairment.
A heightened level of awareness with a comprehensive history and a focused physical examination are essential.
With advancements in biomarkers and emerging neuroprotective and regenerative agents, we can expect an increased role in the primary care medical management of DCM patients soon.
The approach to DCM management is multidisciplinary and generally will involve PCPs, spinal surgeon, physiotherapist, pain specialist, and neurologist.
Patients with query bilateral carpal tunnel syndrome should be assessed for DCM.
Patients with moderate to severe DCM or unequivocal progression of mild DCM require surgical treatment while there exists clinical equipoise between structured non-operative therapies and surgical decompression for mild non-progressive cases of DCM.
Clinically monitor patients with mild DCM frequently and carefully for subtle signs of neurological progression
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
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