Use of quantitative assessment scales in cervical spondylotic myelopathy - survey of clinician's attitudes

Background. There is considerable uncertainty regarding the selection criteria of patients and timing of surgery for cervical spondylotic myelopathy (CSM). Attempts have been made to quantify CSM severity using various assessment scales to provide an adjunct to clinical decision-making. The aim of the present study was to determine, by means of a 7-item questionnaire the attitudes of clinicians regarding the importance of quantitative assessment scales in the management of CSM, their actual use in clinical practice and how current scales fall short of the ideal. Findings. Clinical history, examination, radiological imaging and quantitative functional assessment were regarded by 117 clinicians as being almost equally important in the management of CSM. However, only 22 (19%) of clinicians admitted to using an assessment scale in clinical practice and 4 (3%) believed there was a 'gold-standard' assessment scale. These clinicians also considered 'ease of use' to be the most important attribute of an ideal assessment scale, followed by 'reproducibility', 'sensitivity to change' and 'validity'. Conclusions. The discrepancy between the importance attached to quantitative measurement and its actual use suggests that current scales are under-utilised or unsuitable for clinical practice. A new easy-to use scale may be required that better reflects clinical requirements.