Understanding Gaps in the Diagnosis of Degenerative Cervical Myelopathy in Aotearoa New Zealand’s Primary Healthcare – A Nationwide Cross-Sectional Survey

Abstract

Introduction Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Adequate condition awareness and the ability to recognise key clinical signs are crucial for timely referral and diagnostic imaging. However, the level of awareness and diagnostic confidence among New Zealand primary care clinicians remains unclear.

Aim This study aimed to evaluate self-reported condition awareness, diagnostic confidence, and understanding of DCM signs, symptoms, and management pathways among New Zealand primary care clinicians.

Methods A cross-sectional survey with two sections was developed, piloted, and distributed through professional associations. Participants included general practitioners, nurse practitioners, physiotherapists, osteopaths, and chiropractors. Section A (demographics, DCM education, and ratings of awareness and confidence) was completed by all respondents. Section B (knowledge-based items) was completed by respondents who reported being at least ‘slightly’ confident.

Results The survey yielded 336 responses, of which there were 320 complete responses for Section A and 227 complete responses for Section B. Over half (57.2%) of respondents reported no prior DCM education, and 43.1 and 32.5% reported ‘average’ or ‘limited’ awareness respectively. Low diagnostic confidence was reported by 25.9 (slightly confident) and 22.2% (not at all confident). Symptoms such as upper limb paraesthesia/numbness and neck pain/stiffness were selected by 98 and 95% of respondents as being associated with DCM. The most recognised clinical sign, tandem gait disturbance, was noted by only 65%. Magnetic resonance imaging was identified as the key diagnostic investigation by 73.6%, and 64.8% selected referral to an orthopaedic surgeon, spine surgeon, or neurosurgeon.

Discussion These findings reveal critical gaps in DCM awareness, diagnostic confidence, and knowledge among New Zealand primary care clinicians. It is possible that these gaps contribute to missed and delayed diagnosis for people living with DCM, who subsequently face irreversible neurological compromise resulting from delayed intervention. This study suggests that there is a need for improved education of primary healthcare professionals in regard to this condition and the development of standardised diagnostic criteria.