Diagnostic Delay and Neurological Status at Diagnostic in Patients with Vertebral Destruction Syndrome: Experience at the National Rehabilitation Institute, 2018-2022.

Abstract

INTRODUCTION

The Vertebral Destruction Syndrome (VDS) is a serious condition that may present with neurological deficits significantly affecting the patient's quality of life. Diagnostic delay is one of the main factors involved and is recognized as a modifiable variable with a direct impact on neurofunctional prognosis of the patients. However, there is still a lack of empirical evidence in Latin America. 

OBJECTIVE 

To analyze the diagnostic delay and its association with neurological status at diagnosis in 235 patients with VDS treated at the National Institute of Rehabilitation (INR) between 2018 and 2022. 

MATERIAL AND METHODS

An observational and retrospective study, with a total of  235 patients with VDS, and complete temporal data were analyzed. The diagnostic delay was defined as the number of days elapsed from symptom onset to hospital admission. Neurological status was assessed using the ASIA Impairment Scale. Statistical test: Mann-Whitney U, Kruskal-Wallis, Spearman's correlation (a=0.05).

RESULTS

Median age: 58 years. Predominant etiology: infectious (32.8%). Neurological deficit at diagnosis: 24.3%. Median diagnostic delay: 193 days (6.3 months). Patients with neurological deficits reached the hospital after a median of 122 days, whereas patients without deficits took 216 days. A significant negative corretation was found between diagnostic delay and ASIA severity. Etiology significantly influenced the presence of neurological deficit (χ²=26.36, p<0.001).

CONCLUSIONS

Patients with neurological deficit at diagnosis presented a significantly shorter diagnostic delay than those without a deficit, consistent with a severity bias whereby more alarming symptoms accelerate the care-seeking process. A significant negative correlation between diagnostic delay and neurological severity was identified. Etiology was independently associated with neurological status at diagnosis. These findings highlight the need for early detection strategies targeting patients without established neurological deficits, in whom the window for preventive intervention remains open.