The pattern and chronology of symptom development in degenerative cervical myelopathy: a clinical study

Degenerative cervical myelopathy (DCM) is a common condition caused by cervical spinal cord compression and produces diverse symptoms and neurological deficits. Diagnosis is clinical and corroborated by imaging, yet formal diagnostic criteria and consensus on relevant symptoms are lacking. The aim of this study was to describe the onset and chronology of early symptoms in patients who were already diagnosed with DCM to improve understanding and inform future development of diagnostic criteria.

The authors conducted a prospective cross-sectional study of consecutive patients with DCM at their initial spine surgery visit. They recorded detailed histories of headache, neck and back pain, hand incoordination, gait imbalance, urinary and fecal dysfunction, saddle numbness, sexual dysfunction, and upper extremity (UE) and lower extremity (LE) pain, weakness, and numbness. For each symptom, they captured duration, severity, frequency (days/week), laterality, pattern, progression, and order of onset. The authors assessed Pearson correlations between symptom duration or severity and modified Japanese Orthopaedic Association (mJOA) score.

A total of 138 patients were included in the study. The most common symptoms were neck pain (84.1%), back pain (72.5%), UE numbness (66.7%), gait imbalance (58.0%), and UE incoordination (57.2%). Symptoms most frequently recalled as first were back pain (40.6%), neck pain (31.9%), UE numbness (19.6%), and UE pain (15.2%). The longest mean ± SD pain durations were back pain (8.6 ± 11.7 years), LE pain (6.6 ± 10.9 years), neck pain (6.3 ± 9.5 years), and UE pain (6.2 ± 8.6 years). The most bothersome symptoms were saddle numbness (5.8/10), UE pain (5.2/10), UE weakness (5.1/10), and back pain (5.1/10). Most symptoms occurred frequently (approximately 6 days/week). Common co-occurrences were neck and back pain (65.2%), neck pain and UE numbness (57.2%), and neck pain and gait imbalance (50.7%).

DCM frequently presents with a prodrome of pain before neurological symptoms, with neck and back pain representing the most common and earliest symptoms, while arm pain, leg pain, and headache are also common. Further research is needed to understand the importance of these nonspecific symptoms, which could be early clues that help achieve earlier diagnosis of DCM.