Title : Prospective validation of AJMI grading system for cervical myelopathy. A Decision Support Tool (DST)
Abstract:
Introduction: Cervical myelopathy presents with a range of symptoms, including gait dysfunction (86%), hyperreflexia (79.1%), pathological reflexes (65.1%), upper limb paraesthesia (69.8%), and pain (67.4%).
Materials and Methods: This prospective study included 47 patients attending a spinal outpatient clinic with either an acute presentation of progressive myelopathy, conservative management for cervical myelopathy, or new referrals for assessment. Clinical records were reviewed, and demographic data were collected. The AJMI scores were calculated, incorporating MRI findings as a determining factor. Patients with a zero MRIscore were classified as nonsurgical.
Results: The cohort had a mean age of 63.86 years (range: 48–79), with a higher prevalence among females. Cervical spondylotic myelopathy was the most common diagnosis. The AJMI scores ranged from 0 to 36, with 97% of patients scoring between 6 and 27. The most frequent MRI score was 3, and gait abnormalities were observed in 98% of cases. Patients aged 70–80 were less likely to exhibit all long tract signs.
Conclusion: Our findings suggest that the AJMI score is a highly sensitive tool for diagnosing and guiding the management of cervical myelopathy. Patients requiring surgery typically had scores of 6 or higher, while MRI-negative cases were referred for neurological evaluation instead of surgical intervention. As a single-center study, further multi-center validation is necessary to confirm the generalizability of these results.
