A man in his early sixties in Co Kildare starts fumbling his shirt buttons in the morning. Within a few months he is dropping coins at the till, his handwriting has gone small and untidy, and he has stopped carrying two mugs at once. He puts it down to arthritis. His wife notices something else entirely: he has begun walking the way you walk on ice, even on a dry footpath. Eighteen months after the first button, a neurosurgeon tells him the problem was never in his hands at all. It was in his neck.
That story is a composite, but the timeline is not invented. It is close to the international average, and the research that established it was led from Dublin.
TL;DR
- Degenerative cervical myelopathy (DCM) is slow compression of the spinal cord in the neck by ordinary age-related wear, and it is the commonest cause of spinal cord dysfunction in adults worldwide.
- It announces itself in the hands and the balance, not the neck: buttons, coins, keys, handwriting, and an unsteadiness that is worse in the dark.
- A 2025 meta-analysis led by RCSI and the National Neurosurgical Centre at Beaumont Hospital pooled 78 studies across 18 countries and found the typical gap from first symptom to diagnosis is 15 months.
- In Ireland, degenerative conditions cause 48.8% of all newly acquired non-traumatic spinal cord injury, and non-traumatic injury is more than double the traumatic kind.
- An Irish GP can now refer an adult directly for a free MRI of the cervical spine under the HSE’s GP Access to Community Diagnostics scheme, with no hospital appointment required.
- Surgery works, but its main job is to stop further loss rather than restore what has gone, which is why the delay matters more here than in almost any other neck condition.
What degenerative cervical myelopathy actually is
Everyone’s neck wears. Discs lose height and water, ligaments thicken, small bony spurs form at the joints. This is cervical spondylosis, it shows on the scans of most people over 60, and on its own it is unremarkable. Occasionally, though, that accumulated wear narrows the canal the spinal cord runs through, and the cord itself comes under sustained pressure. Blood supply drops, the insulating myelin suffers, and signals travelling between the brain and the body start to degrade. That is myelopathy, and when ordinary degenerative change is the cause it is called degenerative cervical myelopathy.
The distinction that matters is this one: a trapped nerve root in the neck (radiculopathy) is a wire problem, usually painful, usually confined to one arm, and often it settles by itself. Myelopathy is a cable problem. It affects both sides, below the level of the compression, and left alone it tends to progress in steps rather than resolve.
Why the hands go first
Most people expect a neck condition to hurt in the neck. Neck pain is common in DCM, but it is rarely what brings people to the GP and almost never what gets the condition named. The earliest signals are usually these:
- Loss of hand dexterity. Buttons, shoelaces, zips, coins, keys, jewellery clasps, jar lids. Handwriting that has changed shape. Dropping things without a reason.
- Numbness or pins and needles in both hands, often worse at night, often described as gloved or dead.
- Unsteadiness on the feet rather than dizziness. Wider steps, reaching for walls, noticeably worse in poor light or with eyes closed in the shower.
- Heaviness or stiffness in the legs, and a sense that walking takes concentration it never used to.
- An electric shock down the spine or into the limbs when the chin drops to the chest, known as Lhermitte’s phenomenon.
- Bladder urgency or hesitancy, which typically arrives late and should never be dismissed.
A UK study that mapped patient journeys through a musculoskeletal triage service found DCM was suspected quickly when someone presented with both hand symptoms and a gait disturbance, and stalled when the walking looked normal. The longest delays of all came when people were sent for nerve conduction studies to chase a peripheral neuropathy that was not there.
The Irish figures nobody quotes
Ireland has unusually good data on this, and it is not widely known. A prospective study of every new case of non-traumatic spinal cord injury in the Republic during 2017, published in the Journal of Spinal Cord Medicine, found a crude incidence of 26.9 cases per million people per year, more than double the rate of traumatic spinal cord injury. The mean age at onset was 56.6. The single most common cause was not cancer, infection or a vascular event. It was degenerative conditions of the spine, at 48.8% of all cases. In just over half of all cases, onset was what the researchers called lengthy: more than a month from first symptom to established injury.
Read that together and a clear picture emerges. In Ireland, the likeliest way to acquire a spinal cord injury is not a crash or a fall. It is your own neck, slowly, over months, at an age when most people put the symptoms down to getting older.
A 2021 meta-analysis in Global Spine Journal put the prevalence of DCM in the general adult population at 2.3%, roughly one person in 43. The same study found something equally important: 24.2% of healthy adults have spinal cord compression visible on MRI with no symptoms at all. Compression on a scan is a finding, not a diagnosis. DCM is diagnosed when the imaging and the examination agree.
Why it takes over a year to name
In 2025, a team from RCSI’s School of Physiotherapy and the National Neurosurgical Centre at Beaumont Hospital published the definitive answer in Brain and Spine. Pooling 78 studies from 18 countries covering 12,450 people, they found the time from symptom onset to diagnosis was 15 months, and from onset to surgery 14.5 months. Even counting only from the first clearly myelopathic symptom, people waited 10.7 months for surgery. Their conclusion was blunt: most people with DCM live with symptoms for more than a year before anyone names them.
The reasons are not mysterious. The symptoms mimic carpal tunnel syndrome, peripheral neuropathy, arthritis, Parkinson’s and simple ageing, and they arrive gradually enough that people adapt without noticing. Awareness among first-contact clinicians is also thin: a UK national survey of GPs found 51% rated their own awareness of DCM as limited, and a quarter had received no introduction to the condition at any point in their training.
Irish work is trying to close that gap from the other end. A Beaumont study of 201 consecutive patients referred with a neck problem found 10.4% turned out to have DCM, and that a simple bedside score, the modified Japanese Orthopaedic Association scale (mJOA), was 90% specific for it. Notably, 71.4% of those diagnosed had mild disease, which is exactly when there is most left to protect.
Getting a scan: what an Irish GP can actually do
This is the practical change worth knowing about. Under the HSE’s GP Access to Community Diagnostics scheme, GPs can now refer adults aged 16 and over directly to approved providers for a range of imaging, free of charge to the patient. MRI of the cervical spine, including the cervicothoracic junction, is explicitly on the list. No medical card is required for MRI, and no hospital outpatient appointment is needed first.
The scheme sets a target of one month for urgent referrals and three months for routine ones, and it is designed for people who can safely wait that long. If symptoms are worsening quickly, or there is any new bladder or bowel disturbance, that is not a community MRI situation. That is an emergency department situation, the same day.
If the scan and examination point to DCM, the referral goes on to neurosurgery: in the Republic, the National Neurosurgical Centre at Beaumont Hospital or the neurosciences service at Cork University Hospital.
Treatment, and why the timing is the whole argument
Severity is graded with that same mJOA score: mild is 15 to 17, moderate 12 to 14, severe 11 or below. International AO Spine guidance recommends surgical decompression for moderate and severe disease. For mild disease, surgery is a legitimate option with good outcomes, and the alternative is structured rehabilitation with close surveillance and a low threshold for operating if things slip.
The honest framing of surgery is this: it takes the pressure off and halts the decline, and many people improve, but a cord that has been compressed for two years does not simply reset. What you still have when you reach theatre is largely what you keep. That is the entire case for shortening the 15 months.
Rehabilitation for people not going straight to surgery has been badly under-researched, and Irish clinicians are addressing that too. The ReMiDY trial in Dublin is testing a structured programme of education, physical activity and task-specific hand training against clinical surveillance alone in mild stable DCM.
What to do if this sounds familiar
Book a GP appointment and be specific rather than general. “My hands have got clumsy” is easy to file under arthritis. This is better: name the tasks that have changed, say when they changed, say whether both hands are affected, and mention your walking even if you think it is unrelated. Bring someone who has watched you move, because gait change is far easier to see than to feel. Then ask directly whether this could be coming from your neck.
For support, Myelopathy.org is the international charity dedicated to DCM and runs a helpline and peer support groups. Spinal Injuries Ireland supports people living with spinal cord injury here, including non-traumatic injury, and rehabilitation for non-traumatic cases is provided through the National Rehabilitation Hospital.
Clumsy hands and a careful walk are not an inevitable part of turning sixty. They are a pair of symptoms worth a sentence to your GP, and in Ireland that sentence now has a much shorter route to a scan than it did five years ago.
At Críonna Health we write about ageing as it actually happens, including the conditions that hide behind the phrase “just getting older”. This article is for general information and is not a substitute for individual medical advice: if it described something familiar, bring it to your GP.
📷 Photo by Elio Santos on Unsplash
