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Review
. 2024 May;14(4):1369-1394.
doi: 10.1177/21925682231209869. Epub 2023 Oct 30.

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

Zhilin Jiang  1 , Benjamin Davies  2 , Carl Zipser  3 , Konstantinos Margetis  4 , Allan Martin  5 , Stavros Matsoukas  4 , Freschta Zipser-Mohammadzada  3 , Najmeh Kheram  3   6 , Andrea Boraschi  6 , Elina Zakin  7 , Oke Righteous Obadaseraye  8 , Michael G Fehlings  9 , Jamie Wilson  10 , Ratko Yurac  11 , Chad E Cook  12 , Jamie Milligan  13 , Julia Tabrah  14 , Shirley Widdop  15 , Lianne Wood  16 , Elizabeth A Roberts  15 , Tanzil Rujeedawa  2 , Lindsay Tetreault  7 ; AO Spine RECODE-DCM Diagnostic Criteria Incubator
Affiliations
Review

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

Zhilin Jiang et al. Global Spine J. 2024 May.

Abstract

Study design: Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management.

Objectives: This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM?

Methods: A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies.

Results: This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity.

Conclusion: The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.

Keywords: cervical; degenerative disc disease; myelopathy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
An overview of the search process.
Figure 2.
Figure 2.
Sensitivity and specificity of pathological reflexes in degenerative cervical myelopathy: Results of eleven studies that included a control group.
Figure 3.
Figure 3.
Sensitivity and specificity of hyperreflexia and hyporeflexia in degenerative cervical myelopathy: Results of eleven studies that included a control group.
Figure 4.
Figure 4.
Sensitivity and specificity of sensory and motor impairment and gait dysfunction in degenerative cervical myelopathy: Results of eleven studies that included a control group.
See this image and copyright information in PMC

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