The DOWN Questionnaire: A Novel Screening Tool for Cervical Spondylotic Myelopathy.

STUDY DESIGN: Case-control study. OBJECTIVES: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord injury in adults aged over 55 years. However, since the onset is typically insidious, accurately diagnosing CSM can be challenging, often requiring referral to a subspecialist and advanced imaging. To help identify patients at risk for CSM, this case-control study compared responses to a series of 4 questions (DOWN questionnaire) in myelopathic and non-myelopathic patients. METHODS: Ninety-two patients, 46 with and 46 without myelopathy, were recruited for the study. Each patient answered 4 questions encompassing common symptoms associated with CSM. Responses between patient groups were compared, and Cohen's κ was used to assess for agreement between responses and the diagnosis of myelopathy. RESULTS: We found a sensitivity of 91% and a κ of 0.54 to 3 positive responses and a sensitivity of 72% and a κ of 0.61 to 4 positive responses. CONCLUSIONS: Positive responses to 3 or more DOWN questions has high sensitivity and moderate agreement with the diagnosis of myelopathy based on history, physical exam, and review of advanced imaging by an orthopedic or neurological surgeon. The DOWN questionnaire is a potentially useful screening tool to identify patients at risk for CSM.

The risk of radiation exposure to the eyes of the interventional pain physician.

It is widely accepted that the use of medical imaging continues to grow across the globe as does the concern for radiation safety. The danger of lens opacities and cataract formation related to radiation exposure is well documented in the medical literature. However, there continues to be controversy regarding actual dose thresholds of radiation exposure and whether these thresholds are still relevant to cataract formation. Eye safety and the risk involved for the interventional pain physician is not entirely clear. Given the available literature on measured radiation exposure to the interventionist, and the controversy regarding dose thresholds, it is our current recommendation that the interventional pain physician use shielded eyewear. As the breadth of interventional procedures continues to grow, so does the radiation risk to the interventional pain physician. In this paper, we attempt to outline the risk of cataract formation in the scope of practice of an interventional pain physician and describe techniques that may help reduce them.