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Rahman MM, Abdulla E, Rahman S, Moscote-Salazar LR. Tremor as a symptom of degenerative cervical myelopathy: a systematic review. Br J Neurosurg 2023; 37:245. [PMID: 35531870 DOI: 10.1080/02688697.2022.2072809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Md Moshiur Rahman
- Holy Family Red Crescent Medical College, Neurosurgery, Dhaka, Bangladesh
| | | | - Sabrina Rahman
- Independent University-Bangladesh, Public Health, Dhaka, Bangladesh
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El Khoury M, Mowforth OD, El Khoury A, Partha-Sarathi C, Hirayama Y, Davies BM, Kotter MR. Tremor as a symptom of degenerative cervical myelopathy: a systematic review. Br J Neurosurg 2022; 36:340-345. [PMID: 35132923 DOI: 10.1080/02688697.2022.2033701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AO Spine RECODE-DCM (Research objectives and common data elements for degenerative cervical myelopathy) has highlighted that the subjective disability reported by people living with DCM is much broader than routinely considered today by most professionals. This includes a description of tremor. The objective of this review was to study the incidence and possible aetiology of tremor in degenerative cervical myelopathy (DCM). METHODS A systematic review registered in PROSPERO (CRD42020176905) was conducted in Embase and MEDLINE for papers studying tremor and DCM published on or before the 20th of July 2020. All manuscripts describing an association between tremor and DCM in humans were included. Articles relating to non-human animals, and those not available in English were excluded. An analysis was conducted in accordance with PRISMA and SWiM guidelines for systematic reviews. RESULTS Out of a total of 4402 screened abstracts, we identified 7 case reports and series describing tremor in 9 DCM patients. Papers were divided into three groups for the discussion. The first group includes DCM correctly identified on presentation, with tremor as a described symptom. The second group includes cases where DCM was misdiagnosed, often as Parkinson's disease. The third group includes a single case with a previous history of DCM, presenting with an otherwise unexplained tremor. This grouping allows for the clustering of cases supporting various arguments for the association between tremor and DCM. CONCLUSION DCM can be associated with tremor. The current evidence is restricted to case series. Further study is warranted to establish tremor prevalence, and its significance to assessment and management.
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Affiliation(s)
- Marc El Khoury
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anthony El Khoury
- Southwest Indiana Internal Medicine Residency, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Yuri Hirayama
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark R Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Anne McLaren Laboratory for Regenerative Medicine, Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
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Luo CA, Lu ML, Kaliya-Perumal AK, Chen LH, Chen WJ, Niu CC. Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis. Sci Rep 2020; 10:21188. [PMID: 33273536 PMCID: PMC7712653 DOI: 10.1038/s41598-020-78139-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
When patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.
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Affiliation(s)
- Chi-An Luo
- Department of Orthopaedic Surgery, New Taipei Municipal TuCheng Hospital, New Taipei, 236, Taiwan, ROC.,Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan, ROC
| | - Meng-Ling Lu
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, Spine Division, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan, ROC
| | - Arun-Kumar Kaliya-Perumal
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, Spine Division, Chang Gung Memorial Hospital at Linkou, 5, Fuxing Street, Taoyuan, Guishan, 333, Taiwan, ROC.,Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, 603319, India
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Spine Division, Chang Gung Memorial Hospital at Linkou, 5, Fuxing Street, Taoyuan, Guishan, 333, Taiwan, ROC
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Chung Shan Hospital, Taipei, 106, Taiwan, ROC
| | - Chi-Chien Niu
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan, ROC. .,Department of Orthopaedic Surgery, Spine Division, Chang Gung Memorial Hospital at Linkou, 5, Fuxing Street, Taoyuan, Guishan, 333, Taiwan, ROC.
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