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Treanor C, Gallagher C, Lenehan W, Gantly H, Bolger C, Malone A. Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy. BRAIN & SPINE 2024; 4:102853. [PMID: 39040488 PMCID: PMC11261069 DOI: 10.1016/j.bas.2024.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
Introduction People with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research question Does the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possible DCM? Materials and methods This is a prospective study of consecutive adult patients, referred to a National Neurosurgical Centre with a neck problem. Assessing clinicians undertook standard clinical examination and calculated the mJOA score. A consultant radiologist independently reported radiological findings, after which the assessing clinician determined the diagnosis. The sensitivity and specificity of mJOA for DCM at various cut-points was statistically analysed using Receiver Operating Characteristics (ROC) curves. Results Of 201 patients (98 male, mean age 52.6 ± 13y) assessed over 13 months, 21 were diagnosed with DCM (prevalence 10.4%). Fifteen (71.4%) had a mJOA score classifying disease severity as mild, 4/21 (19%) had moderate disease and two (9.5%) had severe disease. A mJOA score ≤17 (cutpoint ≥1) showed sensitivity of 95% and specificity of 71% for the clinical diagnosis of DCM. mJOA score ≤16 (cutpoint ≥2) had sensitivity of 62% and specificity of 90%. The ROC area under the curve was 0.885 (95% confidence interval: 0.82 to 0.95). 87% of patients were correctly classified. Discussion and conclusion mJOA score ≤16 is 90% specific for a subsequent diagnosis of DCM in people with neck problems and has potential to be used as an early detection tool. Further research is needed to replicate these findings and establish feasibility and acceptability in primary care.
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Affiliation(s)
- Caroline Treanor
- National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Conor Gallagher
- National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Warren Lenehan
- National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Hannah Gantly
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Ciaran Bolger
- National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Neuroscience, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Ailish Malone
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland
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Farahbakhsh F, Khosravi S, Baigi V, Pourghahramani Koltapeh M, Khayyamfar A, Eskandari Z, Ghodsi Z, Harrop J, Rahimi-Movaghar V. The Prevalence of Asymptomatic Cervical Spinal Cord Compression in Individuals Presenting With Symptomatic Lumbar Spinal Stenosis: A Meta-Analysis. Global Spine J 2024; 14:1052-1060. [PMID: 37731268 PMCID: PMC11192137 DOI: 10.1177/21925682231202776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE The aim of this study was to determine the prevalence of asymptomatic cervical spinal cord compression (CSCC) in individuals with lumbar spinal stenosis (LSS). METHODS A systematic electronic search was conducted in Medline, EMBASE, Scopus, and Web of Science without language restriction, with no starting date limit to June 8, 2023, to define the prevalence of asymptomatic CSCC in symptomatic LSS patients. Asymptomatic CSCC was defined based on radiographic studies. All types of studies were included in the review. Meta-analysis was performed on the reported prevalence of asymptomatic CSCC in LSS. RESULTS The database search yielded 10,272 articles. After a full-text review, five studies were included in the final review, comprising a total of 1043 cases. Two studies had a low risk for bias, two moderate, and one estimated to be high risk. The range of prevalence of asymptomatic CSCC in LSS in the five included studies was between 24% and 61%. Meta-analysis on the reported prevalence of asymptomatic CSCC patients with symptomatic LSS demonstrated that the random pooled prevalence was 35% (95% CI: 23 to 48). CONCLUSIONS Asymptomatic CSCC appears to occur in a high number of patients, with this study noting its presence in one-third of patients with LSS. Based on these findings, we strongly recommend that spine surgeons exercise particular caution during the positioning of patients who are undergoing surgery for lumbar stenosis. Furthermore, it is imperative to monitor individuals with symptomatic LSS closely for any potential signs of emerging myelopathy.
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Affiliation(s)
- Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Khosravi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amirmahdi Khayyamfar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Eskandari
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - James Harrop
- Division of Spine and Peripheral Nerve Surgery, Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Correale MR, Soever LJ, Rampersaud YR. A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings. J Prim Care Community Health 2022; 13:21501319221130603. [PMID: 36300425 PMCID: PMC9623358 DOI: 10.1177/21501319221130603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prior to the COVID-19 pandemic, virtual care (VC) was not routinely offered for
assessment of low back pain (LBP), a highly prevalent, disabling condition.
COVID-19 related healthcare closures resulted in a rapid backlog of patients
referred to a provincial interprofessional LBP program. Without management,
these patients were at high risk of experiencing untoward outcomes. Virtual care
became a logical option. However, many clinicians lacked experience and
confidence with LBP virtual care (LBP-VC); and either were unfamiliar with, or
did not have access to, requisite technology. Multi-stakeholder engagement was
utilized to understand barriers, identify enablers, and ultimately promote VC
for LBP. As a result of the multi-stakeholder engagement, the concept of a
toolkit for LBP-VC, including clinical resources and guidelines, emerged. The
toolkit contains preparatory steps for VC and a standardized approach to virtual
LBP assessment. Key steps in the toolkit have potential applicability to other
musculoskeletal populations.
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Affiliation(s)
- Marcia Rebecca Correale
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada,Marcia Rebecca Correale, Schroeder
Arthritis Institute, University Health Network, 399 Bathurst Street, Toronto, ON
M5T 2S8, Canada.
| | - Leslie Jayne Soever
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada
| | - Yoga Raja Rampersaud
- University Health Network, Toronto, ON,
Canada,University of Toronto, Toronto, ON,
Canada,Krembil Research Institute, Toronto,
ON, Canada
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Nouri A, Molliqaj G, Gondar R, Lavé A, Jannelli G, Davies B, Kotter M, Martin A, Virojanapa J, Cheng JS, Somma T, Cappabianca P, Vleggeert-Lankamp CLA, ter Wengel V, Meling T, Schaller K, Tessitore E. Can screening for degenerative cervical myelopathy (SCREEN-DCM) be effectively undertaken based on signs, symptoms and known risk factors? Rationale and research protocol for a prospective, multicentre, observational study. BMJ Open 2022. [PMCID: PMC9301786 DOI: 10.1136/bmjopen-2021-060689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment. Unfortunately, the condition remains poorly recognised and underdiagnosed. To better identify patients, screening tests that target individuals at high risk would be helpful. One group in particular known to have a high prevalence of DCM consists of patients with lumbar degenerative disease (LDD), with the combined presentation referred to as tandem stenosis. Given that LDD is one of the most common presentations in neurosurgical practice and primary care, it is the objective of the proposed study to administer a screening test to these patients as well as those with risk factors or symptoms which raise the suspicion of underlying DCM. Methods and analysis A screening test based on clinical signs/symptoms and known risk factors of DCM was designed. Screening will be performed in neurosurgical consultations for patients with LDD or those with any suspicion of myelopathy. Points are attributed based on the presence of signs/symptoms of DCM (eg, Hoffmann sign, hyper-reflexia) and for comorbidities that predispose or are frequently associated with cervical myelopathy (eg, rheumatoid arthritis, carpal tunnel syndrome). Patients with ≥3 points undergo cervical MRI examination. Patients with positive MRIs will be consulted and receive assessment via modified Japanese Orthopedic Association and Neck Disability Index scores, and subsequent clinical management will be based on practice guidelines. An exploratory multivariate analysis of the effectiveness and efficiency of this proposed screening test will be evaluated after positively screening 50 patients for DCM. Ethics and dissemination This study has received research ethics approval from the Swiss Association of Research Ethics Committees (ID: 2020-02785). The results of this study will be disseminated in a journal targeting physicians commonly encountering patients with LDD.
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