From: Ohaegbulam?hima 0., MD (Neurological Surgery) Date: Tuesday, May 6, 2014 Subject: Cervical Myeiopathy To: William Kois Ed Thank you for the recent referrals. it is sad to see the large number of signi?cantly disabled patients that have come my with conditions that could have been treated more successfully earlier in their clinical course. As you Know, and as we have frequently discussed, the diagnosis of cervical myelopathy is a clinical one rather than radiographic. Most clinicians (certainly most surgeons) would agree that there is enough variability to presentation, and enoughpatients with progressive de?citsin spite of seemingly unconceming MRI reports. that the trigger for surgical intervention is usually derived the history and exam and not primarily the MRI report. if screened patients based on a speci?c measurement of the spinal canal i would be doing several patients a disservice putting them at risk of permanent de?cits 'lt' is sad to see 2131 century patients in the US progressing to wheelchair dependence for cervical rhyelcpathy, when this could be treated. This has been a treatable cause of gait discreet tor several decedes. Only in 3rd World countries 18 it common to see patients and up as disabled from myelopathy as the ones who haVe been showing up after referral from you. i see such patients on visits to Nige'na and really only see them' in Boston when they show up from the 1 be willing to help in any way that i can to facilitate care fer patients as early as possible in their'clinical? - coarse which would greatly enhance their outcome and decrease disability if such treatment is not - available/possible in the VA system The cost of caring for these individuals when they decline to the extent that have recently seen is far greater than what the costs to the system would be with early treatment? and more importantly, the individual would be given a much better quality of life than they are currently endingup with. - Best wishes, Chime 111