Exeter Collaboration for Academic Primary Care (APEx) Blog
Exeter Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
15 April 2026By Lianne Wood – NIHR SPCR Post-doctoral fellow, Bateman Associate Professor of Peripheral Neuropathy
Presenter of APEx Seminar: Degenerative cervical myelopathy: a missed diagnosis? Wednesday 15th April 2026.
This seminar is a summary of the work I have undertaken over the past two years as part of a NIHR SPCR Post-doctoral fellowship. It has been a privilege to have the opportunity to explore this topic in more detail, and I am in the process of trying to finalise and prepare all of this work for publication/ revision.
Degenerative cervical myelopathy (DCM) is an atraumatic condition causing compression of the spinal cord, causing progressive neurological disability and dysfunction. Typical symptoms include numbness or pins and needles, pain and or discoordination in the hands, and unsteadiness in the legs when walking. Surgery is the only treatment to stop progression of the condition and aims to take the compression off the spinal cord. However, awareness of this condition varies across health care professionals. An MRI scan is needed for a diagnosis to be confirmed, and delays in getting these investigations can lead to delays in diagnosis and accessing treatment. Single-centre evaluations estimate patients can take 2-3 years to get a diagnosis. For many, this can come too late, as optimal outcomes from surgery are more likely if surgery is undertaken within 6 months of symptom onset.
My SPCR fellowship aimed to understand the incidence of DCM, and utility of signs and symptoms of DCM prior to diagnosis, as well as to explore the barriers and facilitators to diagnosis of DCM in primary and community care.
I used Clinical Practice Research Datalink (CPRD) Aurum, linked to Hospital records to confirm a diagnosis of DCM. This allowed identification of incident cases within CPRD and to undertake an age-standardised analysis. Using the identified cases, we matched these to controls on age, gender and region. We then explored the characteristics of cases compared to controls, and explored their health care utilisation. We found that cases were more likely to have multiple other ‘mimicker’ diagnoses, and it was unclear whether these were missed diagnoses or additional diagnoses to the DCM. I still plan to undertake the analysis of diagnostic utility of signs and symptoms (using this dataset) in the five-years prior to diagnosis.
I have explored facilitators and barriers to diagnosis and presentation of symptoms prior to a diagnosis through 36 interviews undertaken to date: 10 with people with lived experience and 26 with health care professionals from primary and secondary care settings. I am in the process of securing an extension from IRAS to allow us to recruit additional patients in keeping with our CPRD case characteristics, and to support GP engagement.
I have worked with NHS England and the GIRFT team to explore the accuracy of ICD-10 coding within Hospital Episode Statistics (HES) datasets. We have published this work (Wood et al., 2025), and now are exploring the differences between HES and the British Spinal Registry dataset for people with DCM in terms of surgical characteristics and outcomes. Most patients undergoing surgery appear to have clinically important improvements which are maintained at one-year post-surgery. But, the characteristics of patients across HES and the spinal registry datasets differ, which may have implications for interpretation of results.
Finally, I was invited to spend some time in Norway working with a team from OsloMet and University of Tromso to explore their linked Norwegian Spine Registry (NorSpine) and Pharmacy Records (NorPD)(https://www.linkedin.com/posts/centre-for-intelligent-musculoskeletal-health_aid-spine-part-i-project-center-for-intelligent-activity-7431715868268535808-kY5b?utm_source=share&utm_medium=member_desktop&rcm=ACoAAASPq-gB6_1KTKVGz7YEQEoXZCBkYxGpkdg). We aimed to explore predictors of persistent opioid use at 2 years post-surgery when defined as more than 4500mg oral morphine equivalent dosage or prescriptions over more than ¾ of the year. We found that 11% of those undergoing surgery were persistent users at 2 years post-surgery, and pre-operative medication use was the most important predictor of post-operative medication use.
At present I am in the process of trying to finalise all the outputs of these respective projects, and exploring opportunities for future funding. The publications of these various projects should be finalised over the upcoming months.
One publication:
Wood, L., Hutton, M., Eve-Jones, S., Carpenter, J., Wheeler, A., Briggs, T. W. R., & Gray, W. K. (2025). Variation in diagnostic coding of cervical decompressions in the English Hospital Episodes Statistics dataset. British Journal of Neurosurgery. https://doi.org/10.1080/02688697.2025.2573409