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, vol. 12, pp. e060689

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.

Authors 17

1. Aria Nouri corresponding

   University Hospital of Geneva

   Affiliation as printed

   Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

2. Granit Molliqaj

   University Hospital of Geneva

   Affiliation as printed

   Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

3. Renato Gondar

   University Hospital of Geneva

   Affiliation as printed

   Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

4. Alexandre Lavé

   University Hospital of Geneva

   Affiliation as printed

   Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

5. Gianpaolo Jannelli

   University Hospital of Geneva

   Affiliation as printed

   Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

6. Benjamin Marshall Davies

   University of Cambridge

   Affiliation as printed

   Department of Clinical Neurosurgery, Cambridge University, Cambridge, UK

7. Mark Kotter

   University of Cambridge

   Affiliation as printed

   Department of Clinical Neurosurgery, Cambridge University, Cambridge, UK

8. Allan R. Martin

   University of California, Davis

   Affiliation as printed

   Department of Neurological Surgery, University of California Davis, Sacramento, California, USA

9. Justin N. Virojanapa

   University of Cincinnati · University of Cincinnati Medical Center

   Affiliation as printed

   Department of Neurosurgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA

10. Joseph S. Cheng

    University of Cincinnati · University of Cincinnati Medical Center

    Affiliation as printed

    Department of Neurosurgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA

11. Teresa Somma

    Federico II University Hospital · University of Naples Federico II

    Affiliation as printed

    Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy

12. Paolo Cappabianca

    Federico II University Hospital · University of Naples Federico II

    Affiliation as printed

    Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy

13. Carmen L. A. Vleggeert-Lankamp Aachen Department of Neurosurgery, Leiden University

    Leiden University

    Affiliation as printed

    Department of Neurosurgery, Leiden University, Leiden, The Netherlands

14. Valerie ter Wengel Aachen Department of Neurosurgery, Leiden University

    Leiden University

    Affiliation as printed

    Department of Neurosurgery, Leiden University, Leiden, The Netherlands

15. Torstein Ragnar Meling

    University Hospital of Geneva

    Affiliation as printed

    Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

16. Karl Schaller

    University Hospital of Geneva

    Affiliation as printed

    Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland

17. Enrico Tessitore

    University Hospital of Geneva

    Affiliation as printed

    Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland