Delayed Diagnosis of Cervical Spondylotic Myelopathy
Delayed Diagnosis of Cervical Spondylotic Myelopathy
The medical records, including all community clinic visits, of 146 patients who underwent operation for CSM at our spine surgery unit between January 2009 and December 2010 were analyzed retrospectively. All cervical degenerative pathological conditions were included in the study.
Data were collected from the date of the first documented CSM signs or symptoms until the day of surgery. The study population was composed of 42 patients for whom complete documented medical records were available. The diagnosis of CSM was based on a triad of 1) compatible clinical complaints; 2) neurological examination suggestive of myelopathy; and 3) a cervical MRI study showing spinal cord compression. Patients were excluded from the study for the following reasons: 1) they were suffering from other neurological diseases (for example, amyotrophic lateral sclerosis, Parkinson disease, multiple sclerosis, or prior cerebral vascular attack); 2) they presented with CSM due to neoplastic disease, trauma, or infection; 3) they had previously undergone an operation for CSM; or 4) their clinical data collection was incomplete.
Following chart review, phone interviews were conducted with all patients to complete any missing information and corroborate relevant clinical milestones. Collected data included demographic information, number of physician visits, time delay from the first myelopathic complaint to diagnosis, specialty of the physician who had documented the initial complaint and physician specialties encountered along the diagnostic process, components of the diagnostic workup, alternative diagnoses entertained, and treatments offered and received prior to surgery. The severity of CSM prior to surgery was assessed using the Nurick grading system (Table 1).
All physician visits were counted except for a return visit following referral for lab and imaging studies, which was not counted as an additional visit. The study received approval of the hospital's ethics committee.
Because only 42 patients had complete medical information out of 146 who underwent operation, we determined the randomness of the groups by comparing their demographic data—age, sex, and their Nurick score, where we found no significant difference between patients (p = 0.0749, 0.7109, and 0.0753, respectively).
Descriptive statistics are given as the mean ± SD for age and time to diagnosis. Physician specialty at initial visit and patient symptoms are presented by way of frequency distributions. In addition, the Spearman coefficient was calculated to assess the correlation between time to diagnosis and patient's age. All statistical analyses were performed using SAS for Windows version 9.2.
Methods
The medical records, including all community clinic visits, of 146 patients who underwent operation for CSM at our spine surgery unit between January 2009 and December 2010 were analyzed retrospectively. All cervical degenerative pathological conditions were included in the study.
Data were collected from the date of the first documented CSM signs or symptoms until the day of surgery. The study population was composed of 42 patients for whom complete documented medical records were available. The diagnosis of CSM was based on a triad of 1) compatible clinical complaints; 2) neurological examination suggestive of myelopathy; and 3) a cervical MRI study showing spinal cord compression. Patients were excluded from the study for the following reasons: 1) they were suffering from other neurological diseases (for example, amyotrophic lateral sclerosis, Parkinson disease, multiple sclerosis, or prior cerebral vascular attack); 2) they presented with CSM due to neoplastic disease, trauma, or infection; 3) they had previously undergone an operation for CSM; or 4) their clinical data collection was incomplete.
Following chart review, phone interviews were conducted with all patients to complete any missing information and corroborate relevant clinical milestones. Collected data included demographic information, number of physician visits, time delay from the first myelopathic complaint to diagnosis, specialty of the physician who had documented the initial complaint and physician specialties encountered along the diagnostic process, components of the diagnostic workup, alternative diagnoses entertained, and treatments offered and received prior to surgery. The severity of CSM prior to surgery was assessed using the Nurick grading system (Table 1).
All physician visits were counted except for a return visit following referral for lab and imaging studies, which was not counted as an additional visit. The study received approval of the hospital's ethics committee.
Data Analysis
Because only 42 patients had complete medical information out of 146 who underwent operation, we determined the randomness of the groups by comparing their demographic data—age, sex, and their Nurick score, where we found no significant difference between patients (p = 0.0749, 0.7109, and 0.0753, respectively).
Descriptive statistics are given as the mean ± SD for age and time to diagnosis. Physician specialty at initial visit and patient symptoms are presented by way of frequency distributions. In addition, the Spearman coefficient was calculated to assess the correlation between time to diagnosis and patient's age. All statistical analyses were performed using SAS for Windows version 9.2.
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