DOI: 10.25442/hku.28603085
title: Supporting data for "A novel approach to quantify the impact of spinal cord compression on the physical performance of individuals diagnosed with Degenerative Cervical Myelopathy"

description: Nonspecific signs and symptoms characterize Degenerative Cervical Myelopathy (DCM). Effective management depends on prompt diagnosis and intervention to maintain individual independence and quality of life. Currently, no diagnostic guidelines lead to undiagnosed, delayed, or misdiagnosed cases of other neurological conditions.High-field T2-weighted magnetic resonance imaging (MRI) is currently the gold standard for diagnosing DCM by assessing the extent of spinal cord compression. Nonetheless, diagnosis largely relies on clinical signs and several patient-reported outcome measures, particularly the modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA), which is the most commonly used worldwide. This method is insufficient without objective physical performance data, and the connection between physical performance and spinal cord compression severity is still unclear. Additionally, there is a notable knowledge gap in measuring physical performance in patients with DCM. Therefore, this thesis seeks to improve our understanding of this relationship through a series of studies.A significant link was found between the level of spinal cord compression and the outcomes of bedside physical performance assessments, which have proven to be reliable for assessing and monitoring DCM in the systematic review. These results support and strengthen the theory that physical performance tests are useful for detecting and following the progression of DCM.Several knowledge gaps hinder further investigations. Firstly, the importance of various physical performance tests regarding spinal cord compression severity in DCM remains unexplored. Secondly, no diagnostic criteria exist to assess significant spinal cord compression. Thus, clinical studies aimed to develop a novel integrative scoring system for physical performance in DCM and establish thresholds for those at risk of neurological deterioration, as indicated by the critical cross-sectional area in MRI.A new integrative scoring system for physical performance, the Hong Kong Myelopathy Criteria (HKMC), provides thresholds for DCM patients at risk of neurological decline, allowing for the identification of individuals with significant spinal cord compression. A noteworthy number of DCM patients were detected using HKMC, which demonstrated high sensitivity and specificity, resulting in diagnostic accuracy that outperformed the traditional standard, the mJOA. Moreover, the effectiveness of HKMC was confirmed in tracking disease progression and recovery after decompressive surgery in DCM patients, showing greater utility compared to the mJOA Additionally, the minimum clinically important differences (MCID) for monitoring disease and post-operative recovery have been defined, showing significant sensitivity and specificity that relate to the quality of life in patients with DCM.In summary, this research developed a novel integrative scoring system intended to quantify functional deficits resulting from spinal cord compression in DCM patients. The thresholds for individuals at risk of neurological decline aid in clinical diagnosis. The efficacy of HKMC in disease progression and post-surgery recovery monitoring is notable, as evidenced by the overall improvement in patient satisfaction regarding their quality of life.