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

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.

Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy

“…A recent narrative review points to low awareness of DCM ( Davies et al, 2022 ). The diagnosis relies on triangulation of patient-reported symptoms with clinical findings of upper motor neuron signs and MRI evidence of cord compression, but clinical signs can be subtle and non-specific ( Jiang et al, 2023 ) and MRI evidence alone is not definitive for clinical DCM due to the high incidence of non-myelopathic spinal cord compression in healthy individuals ( Nouri et al, 2022 ). Many people with DCM present with non-conventional symptoms ( Munro et al, 2023 ) which could divert investigations away from myelopathy as a potential diagnosis.…”

“…It is quick to administer and captures, in a single score, the symptoms that raise suspicion of DCM. Capturing patient-reported symptoms of myelopathy is particularly important given that DCM can present without clinical neurological signs ( Jiang et al, 2023 ). It could assist with clinical decision-making at first assessment by synthesising the key points from subjective assessment into a single score for onward referral to specialist spine care, including potential fast-track for urgent surgical review of people with moderate and severe DCM and/or monitor for any progressive deterioration in function in patients who require follow up review.…”