scholarly journals A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers (Preprint)

2018 ◽  
Author(s):  
Benjamin Marshall Davies ◽  
Colin Fraser Munro ◽  
Mark RN Kotter
Keyword(s):  
Cervical Myelopathy ◽  
Correct Diagnosis ◽  
Web Based ◽  
Delay In Diagnosis ◽  
Arm Pain ◽  
The Mean ◽  
Degenerative Cervical Myelopathy ◽  
Google Search ◽  
Insight Into ◽  
Better Than

BACKGROUND Degenerative cervical myelopathy (DCM) is a common debilitating condition resulting from degeneration of the cervical spine. While decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Early surgery improves the likelihood of recovery, yet the average time from the onset of symptoms to correct diagnosis is over 2 years. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of DCM by symptom checkers may contribute to the delay in diagnosis. OBJECTIVE The aims of this study were to investigate whether Web-based symptom checkers were able to recognize relevant symptoms of DCM, to characterize the DCM differential they returned , and to evaluate the diagnostic performance of recognized DCM symptoms. METHODS We pooled classical DCM symptoms from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4; Google Search). The most widely cited symptom checker, WebMD, was used to characterize the differential diagnosis for DCM symptoms. RESULTS A total of 31 classical DCM symptoms were identified, of which 45% (14/31) listed DCM as a differential and 10% (3/31) placed DCM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than that for arthritic symptoms (P=.01) and the average differential rank for all symptoms (P=.048). The symptom checker WebMD performed best at recognizing DCM, placing the condition nearer to the top of the differential list (mean rank of 5.6) than either Healthline (rank of 12.9, P=.02) or Healthtools.AARP (rank of 15.5, P=.001). On WebMD, only one combination of symptoms resulted in DCM as the primary differential: neck, shoulder, and arm pain with hand weakness. Moreover, 151 differential diagnoses for DCM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% (16/31) and 32% (10/31) of the DCM symptoms, respectively. CONCLUSIONS DCM symptoms are poorly identified by Web-based symptom checkers, which leads to a large differential of many other common conditions. While a diagnosis becomes more likely as the number of symptoms increases, this represents more advanced disease and will not support much-needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimization.

scholarly journals On Efficient Estimation of Process Variability

Symmetry ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 554
Author(s):  
Tanveer Akhlaq ◽  
Muhammad Ismail ◽  
Muhammad Qaiser Shahbaz
Keyword(s):  
Numerical Study ◽  
Empirical Studies ◽  
Efficient Estimation ◽  
Process Variability ◽  
Good Insight ◽  
Exponential Method ◽  
Process Dispersion ◽  
The Mean ◽  
Insight Into ◽  
Better Than

Variability or dispersion plays an important role in any process and provides insight into the spread of data from some central point, usually the mean. A process with less spread is preferred over a process in which values differ greatly from the mean. Various methods are available to estimate the process dispersion by using information on the variable of interest. Certain additional variables provide good insight to estimate the process dispersion. In this paper, we propose an efficient method for the estimation of process variability by using the exponential method. The properties of the proposed method were studied. We conducted simulation and empirical studies to compare the proposed method with some existing methods of estimation of variability. The results of the numerical study show that our proposed method is better than the other methods used in the study.

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

2014 ◽  
Vol 21 (3) ◽  
pp. 400-410 ◽  
Author(s):  
Li-Yu Fay ◽  
Wen-Cheng Huang ◽  
Jau-Ching Wu ◽  
Hsuan-Kan Chang ◽  
Tzu-Yun Tsai ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Heterotopic Ossification ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Viable Option ◽  
Cervical Arthroplasty ◽  
Arm Pain ◽  
Significant Difference ◽  
The Mean

Object Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. Methods A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Results Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24–56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. Conclusions The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

scholarly journals Attitudes on vaccination among Portuguese travelers and Brazilian migrans: A pilot study in Portugal

2019 ◽  
Vol 49 ◽  
Author(s):  
Ricardo Igreja ◽  
Katy Barros ◽  
Rosa Teodosio
Keyword(s):  
Pilot Study ◽  
Protective Effect ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Web Based ◽  
The Mean ◽  
Self Administered Questionnaire ◽  
Travel Clinic ◽  
Better Than

Introduction: Anti-vaccination movements exist in Europe and it may reduce adherence to international vaccination.Objectives:To evaluate attitudes on vaccination among Portuguese travelers and Brazilian migrants in Portugal.Material and Methods:Between May and June 2019 a cross-sectional survey was carried out in the Travel Clinic of the Institute of Hygiene and Tropical Medicine of Lisbon. A self-administered questionnaire was applied after medical consultation. Travelers were asked about their attitudes to vaccines. An anonymous web-based survey was sent to Brazilian migrants living in Portugal for at least 6 months.Results: 55 Portuguese (P) travelers and 22 Brazilian (B) migrants answered the questionnaire. 47.3% of Portuguese travelers were male; the mean age was 33 years; reason for travel: tourism (43.6%) or business (30.9%). 31.8% of Brazilian migrants were male and the mean age was 44 years; 71.4% were living in Portugal for ≤ 2 years. Attitudes towards vaccines: 64.8% P and 68.2% B prefer to vaccine even when the risk of acquire a disease is low; 64.1% P and 95.5% B consider that the resistance acquired by disease is better than resistance acquired by vaccine; 75.5% P and 77.3% B prefer to vaccine even when diseases are not severe; 5.6% P and 13.6% B don’t take vaccines because they are afraid of side effects.About the reasons to accept a vaccine, travelers/migrants consider very important to trust in the doctor (100% P, 95.4% B), and the excellent protective effect of a vaccine (98.1% P, 90.9% B).Conclusions: Portuguese travelers and Brazilian migrants in Portugal seem to have a favorable attitude towards vaccination, despite the anti-vaccination movements in Europe. They believe that trust in the doctor and excellent protection of the vaccines are reasons to accept it. The quality of traveler's advice may maintain/increase adherence to vaccination. 

Surgical Treatment of Multilevel Degenerative Cervical Myelopathy: Open-Door Laminoplasty and Fixation via Unilateral Approach. A Feasibility Study

2021 ◽  
Author(s):  
Gregor Schmeiser ◽  
Janina Isabel Bergmann ◽  
Luca Papavero ◽  
Ralph Kothe
Keyword(s):  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Open Door ◽  
Lateral Mass Screw ◽  
Unilateral Approach ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Abstract Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM). Methods A retrospective cohort analysis of 46 prospectively enrolled patients (23 uLP and 23 LC). The minimum follow-up was 1 year. Neck and arm pains were evaluated with visual analog scales and disability with the Neck Disability Index (NDI). Myelopathy was rated with the modified Japanese Orthopaedic Association (mJOA) score. Cervical sagittal parameters were measured on plain and functional X-ray films with a specific software. The statistical significance was set at p < 0.05. Fusion was defined as <2 degrees of intersegmental motion on flexion/extension radiographs. Results The two groups were similar in age and comorbidities. The mean operation time and the mean hospital stay were shorter in the uLP group (p = 0.015). The intraoperative blood loss did not exceed 200 mL in both groups. At follow-up, the groups showed comparable clinical outcome data. The sagittal profile did not deteriorate in either group. Fusion rates were 67% in the uLP group and 92% in the LC group. No infections occurred in either group. In the LC group, one patient developed a transient C5 palsy. Revision surgery was required for a malpositioned screw (LC) and for one implant failure (uLP). Conclusion Laminoplasty and unilateral fixation via a unilateral approach achieved comparable clinical and radiologic results with laminectomy and bilateral fixation, despite a lower fusion rate. However, the surgical traumatization was less.

scholarly journals Influence of Preoperative Smoking Status on Clinical Outcomes of Laminoplasty in Patients With Degenerative Cervical Myelopathy: a Prospective Study

2021 ◽  
Author(s):  
Guoyan Liang ◽  
Qifei Duan ◽  
Chong Chen ◽  
Xiaoqing Zheng ◽  
Changxiang Liang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Smoking Status ◽  
Arm Pain ◽  
Degenerative Cervical Myelopathy ◽  
A Prospective Study

Abstract Background: Smoking is considered to be a risk factor for poor clinical outcomes after anterior cervical decompression and fusion surgery. However, it is unclear whether the preoperative smoking status has similar effects on clinical outcomes after laminoplasty. The current research is carried out to determine whether smoking status before laminoplasty affects clinical outcomes in patients with degenerative cervical myelopathy (DCM). Methods: A series of consecutive patients undergoing laminoplasty to treat DCM at a single institution between April 2017 and April 2020 were included. The patients were divided into the following 3 groups: active smoking (AS), passive smoking (PS), and non-smoking (NS). The primary outcome was the recovery rate of JOA at the last follow-up. Secondary outcomes included JOACMEQ score and the NRS (Numerical rating scale) for neck and arm pain. Statistical analysis of among the three groups differences were performed with ANOVA, and multivariable regression analysis was undertaken to explore predictor variables.Result: A total of 158 consecutive patients completed at least 6 months of follow-up. There were 108 men and 50 women. The mean (±standard deviation) age of this series was 57.7 ± 11.6 years. The average recovery rate of JOA, the improvement in the NRS for neck and arm pain, and in each domain of JOACMEQ did not differ significantly among the three groups (P＞0.05). When used 52.8% as the minimal clinically important difference (MCID) of the JOA recovery rate, active smokers (RR=0.950, 95%CI=0.740-1.220) and passive smokers (RR=0.830, 95%CI=0.540-1.277) had similar likelihoods of reaching MCID compared with non-smokers. Logistic regression revealed that age (OR=0.95, 95%CI=0.92-0.98, P=0.001) and preoperative JOA (OR=0.85, 95%CI=0.75-0.95, P=0.004) were risk factors of the recovery rate that did not reach MCID, but smoking status: AS (OR=0.56, 95%CI=0.21-1.47,P=0.24), PS (OR=.087, 95%CI=0.43-1.76, P=0.70), did not affect the clinical outcomes.Conclusion: Over a follow-up period of at least 6 months, active smokers, passive smokers, and non-smokers had similar improvements in clinical outcomes after laminoplasty. Thus, smoking status was not found to be an independent predictor of clinical outcomes after laminoplasty.

Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

2021 ◽  
pp. 1-11
Author(s):  
Mark D. Dijkman ◽  
Martine W. T. van Bilsen ◽  
Michael G. Fehlings ◽  
Ronald H. M. A. Bartels
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Minimal Clinically Important Difference ◽  
Clinically Important Difference ◽  
Surgical Data ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0–18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

P85 Waiting time for operative management of degenerative cervical myelopathy (DCM) and its impact on outcome

2019 ◽  
Vol 90 (3) ◽  
pp. e44.1-e44
Author(s):  
PL Lawrence
Keyword(s):  
Waiting Time ◽  
Cervical Myelopathy ◽  
Wait Time ◽  
Operative Management ◽  
Female Ratio ◽  
The Mean ◽  
The Individual ◽  
Tendency Analysis ◽  
Degenerative Cervical Myelopathy ◽  
Male To Female

ObjectivesTo audit the waiting time for patients with degenerative cervical myelopathy (DCM ) and its impact on outcome in the Imperial College NHS Trust (ICNHST) against the latest AO standard.DesignRetrospective analysis.Subjects1. Waiting time for surgery and impact on outcome for DCM. 2. Operative approach.MethodsThe medical records of 107 patients who had undergone surgery for DCM at ICNHST in 2016 to 2017 was reviewed. Central tendency analysis of nominal and ordinal variables such as surgery waiting time and demographics were assessed using Microsoft excel.ResultsThe mean age reviewed was 58.2 years. Male to female ratio was 1:1. The mean wait time was 10.22 overall. However, 58% of cases were moderate with mean wait time in that stratum at 4 weeks. Most patients improved at 3–6 months by 2 points on the mJOA regardless of approach done although 63% of cases were anterior. The results were compatible with the latest AO recommendations except for mild patients where it seemed more efficient to converse about morbidity of surgery vs myelopathy in the first instance, since disease burden is tolerable and plated in most hence risk may outweigh benefit. The approach chosen should be individually chosen based on a gestalt of patient and disease factors since results are equivocal.ConclusionsThe approach to the cervical myelopathy must be taken at the merit of each patient based on a gestalt of the individual clinical factors involved. However, default approach to limiting wait to under 4 weeks is reasonable.

scholarly journals Outcome of Laminoplasty in Patients with Multilevel Cervical Myelopathy

2019 ◽  
Vol 23 (3) ◽  
pp. 212-216
Author(s):  
FAIQ SHEIKH ◽  
FAHEEM AHMAD USMANI ◽  
ADNAN KHALID ◽  
TARIQ SALAHUDDIN ◽  
JAMAL NASIR
Keyword(s):  
Cervical Myelopathy ◽  
Case Series ◽  
P Value ◽  
Reliable Technique ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Multilevel Cervical Myelopathy ◽  
Degenerative Cervical Myelopathy ◽  
Degenerative Cervical Spine

Objective: To determine the outcome of surgical intervention in the form of laminoplasty in the patients with multilevel cervical myelopathy. Material and Methods: Descriptive case series, was conducted at NS-I, PINS, Lahore for 6 months. The patients were included through non probability consecutive sampling that fulfilled inclusion criteria. All of the patients were assessed using JOA score before and after 2 months of surgery. General characteristics, including age, gender, other medical conditions and other risk factors were assessed prior to surgery. The total number of 35 patients was included with expected JOA percentage recovery rate of 75% + 21% after the procedure. Results: In this study 35 total patients were enrolled. The mean age was 55.68 + 9.92 years. Total number of male patients were 23 (65.71), while the female was 12 (34.29). The mean duration of degenerative cervical myelopathy was 3.90 + 1.3 months. The mean pre op value of JOA score was 7.08 + 2.7 (4 – 10) for the patients. The mean post op score was 13.00 + 2.30 (9 – 17). The mean recovery value calculated at two month interval was 62.12 + 17.39 (38.46 – 100). Statistically, there was a significant difference of outcome of pre and post op value of JOA scores i.e., p value = 0.00. Conclusion: Our study determined that, the open door laminoplasty is an effective and reliable technique with good outcome in the treatment of multi-level degenerative cervical spine myelopathy patients. 

Causes, Patterns, and Outcomes of Nontraumatic Spinal Cord Injury

2021 ◽  
pp. 9
Author(s):  
Mutlaq AlMutlaq
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Stenosis ◽  
Cervical Myelopathy ◽  
Thoracic Injuries ◽  
Cord Injury ◽  
Asia Score ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Introduction: Nontraumatic spinal cord injury (NTSCI), refers to damage to the spinal cord resulting from a cause other than trauma. It is a condition with immense functional implications for individuals involved. The incidence of NTSCI is difficult to estimate due to its heterogeneous cluster of a wide spectrum etiologies with varying pathophysiology. The most described NTSCI causes are degenerative diseases and spinal stenosis, tumors, and inflammatory conditions. In order to avoid delay in diagnosis and time-critical treatment, knowledge of each is important. We aim to fill the gap of knowledge by assessing the causes, patterns, and outcomes of NTSCI. Methodology: This retrospective cohort study included all patients who had an NTSCI between 2016 and 2020. In addition, patients aged >18 years and treated surgically were included. Demographic and clinical data were collected. Pre- and postoperative American Spinal Injury Association (ASIA) impairment scales and last follow-up outcomes were assessed. Result: A total of 124 patients were included. The mean age of our population was 62.8 years with an average BMI of 31; 8% of them were smokers. Upon admission, back pain (45%), numbness (43%), and inability to walk (18%) were the highest recorded clinical presentations. Spinal stenosis (45%) followed by degenerative cervical myelopathy (27%) were the most observed pathologies. Lumbar injuries accounted for 45% whereas cervical injuries accounted for 41% and thoracic injuries for 14%. The average length of stay period was 23.2 days, with 48% of patients transferred to inpatient rehabilitation, and the mean follow-up duration was 15 months. Conclusion: In summary, after assessing the causes, patterns, and outcomes of NTSCI, our study showed that comorbidities were observed in 85% of patients. Spinal stenosis and degenerative cervical myelopathy were the most common etiologies. Patients who presented with urinary incontinence and/or bowel incontinence upon admission had a significantly worse ASIA score at last follow-up. Degenerative pathologies recorded a worse ASIA score, and thoracic injuries recorded the worst ASIA score improvement compared to cervical and lumbar injuries. In total, 57% of the patients showed full recovery at the last follow-up.

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