A doctor will consider three elements when formulating a diagnosis of Degenerative Cervical Myelopathy (DCM):
1) Clinical Presentation
- History – Often the time course is long and it can be difficult to determine when the symptoms first started. The doctor will want to distinguish other causes of similar symptoms, e.g. trauma, infection, or other neurological diseases.
- Symptoms – DCM can cause a variety of symptoms. Your doctor will want to know what symptoms you attribute to your DCM, including when you first noticed them, how they have progressed over time, how they affect you, and how you manage them.
- Additional information – People often arrive at a consultation having had DCM for a long time. Doctors will want to know whether any tests have already been carried out (e.g. an MRI Scan). Given that DCM sometimes requires an operation, they will also need to know what other medical conditions you may suffer from and what types of medication you take, as this information will be important for any general anaesthetic. See our list of questions you should be prepared to answer before your doctor visit.
2) Neurological Examination
The cervical part of the spinal cord controls everything in your body from the neck downwards. During your consultation, your doctor will carry out a careful assessment particularly focusing on your arms and legs. The examination will involve:
- testing your muscle strength
- testing your reflexes (tapping parts of your body with a hammer, and watching the response of muscles)
- testing your sensation (e.g. whether a pin feels sharp)
- testing your stiffness (moving your limbs whilst you leave them completely relaxed)
3) Imaging and Nerve Conduction Studies
Magnetic Resonance Imaging (MRI) is required to diagnose DCM. In most cases, MRI reveals compression of the spinal cord.
It should be made clear that the degree of cord compression a person has does not correlate with symptoms. Everyone will differ in the degree of cord compression and the nature, duration and severity of their symptoms.
Because MRI uses magnets, patients who have certain types of metal implanted from previous operations are not able to undergo this test. In these circumstances, alternative tests are used. Your doctor will determine whether you are eligible for an MRI and will discuss the alternatives with you.
See our MRI Safety Questionnaire to see if you can have an MRI. Please note that the questions outlined in the checklist may vary between healthcare centres.
Other investigations may include:
X-ray – this can highlight bony arthritic changes, but will not show soft structures such as the spinal cord. Its role is only to guide surgical planning and follow up.
CT Scan – this a special type of 3D X-ray, so it will highlight bony arthritic changes, but does not allow visualisation of soft structures such as the spinal cord.
CT Myelogram – this is a type of CT scan that involves dye being injected into your back, which allows the X-ray to show up the soft spinal cord structures. This is typically reserved for people unable to undergo an MRI, such as those who have magnetic implants (e.g. historic pacemakers, or surgical implants).
Nerve Conduction Study – this can test how well the nerves in your arms and legs are working and can be useful for distinguishing radiculopathy from DCM.
It is not uncommon for DCM to be diagnosed as part of a sudden, rapid deterioration in someone’s condition, for example after a fall. Under these circumstances, referral to a neurosurgeon is required as soon as a diagnosis has been confirmed using imaging. Rapid deterioration of symptoms warrants early treatment.