[Analysis of the causes of late diagnosis of vascular myelopathy]

To identify and detail the main causes of late diagnosis of vascular myelopathy.

A retrospective and prospective study of 77 patients diagnosed with vascular myelopathy (G95.1) treated at Pavlov University between 2020 and 2024 was conducted. The diagnosis was made after a comprehensive examination and exclusion of other compression and non-compression causes of myelopathy. After the diagnosis was verified, patients were divided into two groups: Group 1 (n=21, 27.3%) included patients admitted with a previously diagnosed vascular myelopathy, and Group 2 (n=56, 72.7%) included patients admitted with a different, incorrect diagnosis.

It was found that 27 patients (48.2%) of Group 2 and 1 patient (4.8%) of Group 1 (p=0.0004, OR=18.62, 95% CI 2.34-148.4) were not hospitalized in the first three days from the onset of the disease in a facility equipped with the necessary laboratory and instrumental equipment to establish the cause of myelopathy. Thirty (53.6%) patients in Group 2 had significant deviations in the primary interpretation of the medical history and clinical presentation, whereas in Group 1, such deviations were detected in 1 (4.8%) patient (p<0.0001, OR=23.1, 95% CI 2.89-183.9). MRI was not performed in the first three days after admission to the hospital in 47 (90.4%) patients of Group 2 and 9 (45.0%) patients in Group 1 (p<0.0001, OR=11.5, 95% CI 3.21-41.12). Patients with an incorrect diagnosis had a significantly severe disability (p<0.001), while patients with a correct diagnosis demonstrated better functional independence (p<0.001).

Three groups of causes of late diagnosis of vascular myelopathy were identified: related to the delay in medical care and patient routing, incorrect interpretation of the history and clinical presentation, and late neuroimaging. To improve the quality of care, it is necessary to raise awareness of the clinical manifestations and modern methods for diagnosing spinal cord infarction, ensure the accessibility of the necessary diagnostic tests, and improve patient routing.