Prevalence, patterns and associated factors of degenerative cervical myelopathy in degenerative cervical spine patients attending Mulago Hospital Spine Unit

Abstract

Introduction: Degenerative cervical myelopathy is a common cause of progressive spinal cord dysfunction and functional impairment among individuals above 50 years. Its diagnosis is guided by both clinical and radiological findings. The cause and level of spinal cord compression in the cervical spine is best described by magnetic resonance imaging. Due to its subtle early symptoms, age at presentation, comorbidities, and limited access to magnetic resonance imaging, diagnosis in a primary care setting is delayed leading to severe impairment. Thus, a high index of suspicion of the disease based on clinical presentation is key to early diagnosis. Objective(s): To describe the prevalence, clinical and radiological presentation and associated factors of patients with Degenerative Cervical Myelopathy presenting at Mulago National Referral Hospital Spine Unit. Methods: A cross-sectional study was conducted in the Spine Unit at Mulago National Referral Hospital. One hundred and thirty four study participants were recruited through consecutive sampling. Data was collected using a pre-tested questionnaire. Dependent and independent variables were analyzed using SPSS version 22. The findings of the study provided baseline data on prevalence, clinical, radiological presentation and associated factors of DCM patients to enable early clinical diagnosis in primary care settings. It is hoped that the study will stimulate further research on DCM Results: A total of 134 patients with degenerative cervical spine disease were enrolled in the study of which 75 had degenerative cervical myelopathy resulting in a prevalence of 55.9%. In this study males were the most predominant sex while the most commonly affected age group was above 60 years. Sensory impairment and spasticity ranked as the commonest symptom and sign respectively while degenerative disc changes with disc herniations/ bulges was the most observed MRI finding. Almost half of the patients were scored as severe DCM by mJOA classification. Age, BMI, tobacco use and lumbar spine disease were found to have an association with DCM. Conclusion: DCM is a common condition in degenerative cervical spine patients aged 50 and above with a high prevalence in our setting with severe implications on neurological function. Medical practitioners dealing with patients in this age group should therefore maintain a high index of suspicion and actively assess and investigate for DCM in these individuals