Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Purpose: The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon’s geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results: A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion: More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe

Targeting earlier diagnosis: What symptoms come first in Degenerative Cervical Myelopathy?

BackgroundDegenerative cervical myelopathy (DCM) is a common and disabling condition. Early effective treatment is limited by late diagnosis. Conventional descriptions of DCM focus on motor and sensory limb disability, however, recent work suggests the true impact is much broader. This study aimed to characterise the symptomatic presentation of DCM from the perspective of people with DCM and determine whether any of the reported symptoms, or groups of symptoms, were associated with early diagnosis.MethodsAn internet survey was developed, using an established list of patient-reported effects. Participants (N = 171) were recruited from an online community of people with DCM. Respondents selected their current symptoms and primary presenting symptom. The relationship of symptoms and their relationship to time to diagnosis were explored. This included symptoms not commonly measured today, termed 'non-conventional' symptoms.ResultsAll listed symptoms were experienced by >10% of respondents, with poor balance being the most commonly reported (84.2%). Non-conventional symptoms accounted for 39.7% of symptomatic burden. 55.4% of the symptoms were reported as an initial symptom, with neck pain the most common (13.5%). Non-conventional symptoms accounted for 11.1% of initial symptoms. 79.5% of the respondents were diagnosed late (>6 months). Heavy legs was the only initial symptom associated with early diagnosis.ConclusionsA comprehensive description of the self-reported effects of DCM has been established, including the prevalence of symptoms at disease presentation. The experience of DCM is broader than suggested by conventional descriptions and further exploration of non-conventional symptoms may support earlier diagnosis

Survey symptom classification–non-conventional symptoms.

Survey symptom classification–non-conventional symptoms.</p

Pie chart illustrating the proportion of overall symptoms reported that were attributable to each symptom category.

Conventional symptom segments are illustrated with lines and non-conventional symptom segments with dots.</p

Pie chart illustrating the proportion of initial symptoms that were attributable to each symptom category.

Conventional symptom segments are illustrated with lines and non-conventional symptom segments with dots. Categories with N ≤ 1 have been left out for the purposes of clear illustration.</p

Odds of early diagnosis using symptom categories.

A forest plot of individual odds ratios for each symptom category. Error bars represent 95% confidence intervals of the odds ratio. Categories with N ≤ 1 have been left out for the purposes of clear illustration.</p

Short and longlisted survey outcomes.

*Outcomes added after respondent suggestion in round 2. 2 shortlisted symptoms (italicised) were expanded “anatomically” for the longlist. (DOCX)</p

Flowchart of the study design.

The findings from previous semi-structured (Round 1) interviews [20] and paired internet survey (Round 2) [16], were used to produce this survey (Round 3).</p

Bar chart of the prevalence of symptoms.

The number of respondents reporting each symptom are displayed at the end of the bar.</p