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A protocol for developing screening criteria for degenerative cervical myelopathy: AO Spine Myelopathy.org RECODE-DCM
(Springer Science and Business Media LLC, 2026-04-04)
Lindsay Tetreault
;
Tanzil Rujeedawa
;
Lance A. Burn
;
Carl Zipser
;
Chad Cook
2
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Healthcare Provider Perspectives of Various Signs and Symptoms for Diagnosing Degenerative Cervical Myelopathy: Results of an International, Multidisciplinary Survey
(Wiley, 2025-12-03)
Lance A. Burn
;
Tanzil Rujeedawa
;
Abdul Lalkhen
;
Allan R. Martin
;
Anna MacDowall
<jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Introduction/Aims</jats:title> <jats:p> Diagnosis of degenerative cervical myelopathy ( <jats:styled-content style="fixed-case">DCM</jats:styled-content> ) is frequently delayed. A lack of awareness and standardized screening criteria have been identified as major contributors. The objective of this study was to conduct a survey of international experts to determine the value of various signs and symptoms in diagnosing patients with <jats:styled-content style="fixed-case">DCM</jats:styled-content> . This study forms part of a three‐step initiative that aims to develop pragmatic screening criteria for <jats:styled-content style="fixed-case">DCM</jats:styled-content> . </jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p> An open voluntary English‐language Likert scale survey was disseminated among international networks of experts in <jats:styled-content style="fixed-case">DCM</jats:styled-content> . Respondents were asked to rank each sign or symptom on a scale of 0 ( <jats:italic>not important at all</jats:italic> ) to 10 ( <jats:italic>extremely important</jats:italic> ); a mean value of ≥ 6.5 was set a priori as the threshold to consider a feature as having significant diagnostic value. </jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fifteen symptoms and 12 signs were ranked as having significant diagnostic value. The most highly ranked symptoms are primarily related to abnormalities of the upper limb, hand function, and gait. The top‐rated signs included pathological reflexes as well as impairment of motor function, gait, and coordination. Features ranked as significant were largely consistent across professions, levels of experience, and continental regions.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p> The integration of expert stakeholder opinion with evidence from existing literature strengthens the clinical framework for identifying key clinical features of <jats:styled-content style="fixed-case">DCM</jats:styled-content> . These 27 features will be discussed at an international consensus meeting to establish a standardized clinical screening toolkit that can be used by frontline healthcare professionals to detect patients with <jats:styled-content style="fixed-case">DCM</jats:styled-content> . </jats:p> </jats:sec>
1
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The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review
(2023)
Zhilin Jiang
;
Benjamin Davies
;
Carl Zipser
;
Konstantinos Margetis
;
Allan Martin
<jats:sec><jats:title>Study Design</jats:title><jats:p> Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. </jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p> This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM. </jats:p></jats:sec>
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The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis
(2023)
Zhilin Jiang
;
Benjamin Davies
;
Carl Zipser
;
Konstantinos Margetis
;
Allan Martin
<jats:sec><jats:title>Study Design</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p> 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? </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> 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. </jats:p></jats:sec>
3Scopus© Citations 37
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Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury
(2021)
Carl M. Zipser
;
Konstantinos Margetis
;
Karlo M. Pedro
;
Armin Curt
;
Michael Fehlings
<jats:title>Abstract</jats:title><jats:p>Degenerative cervical myelopathy (DCM) is a common non-traumatic spinal cord disorder and characterized by progressive neurological impairment. Generally, it is still underdiagnosed and referral to spine specialists is often late, when patients already present with incomplete cervical spinal cord injury (SCI). To improve early diagnosis and accelerate referral, diagnostic criteria for DCM are required. Recently, AO Spine RECODE- DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) (aospine.org/recode), an international, interdisciplinary and interprofessional initiative, including patients with DCM, was funded with the aim to accelerate knowledge discovery that can change outcomes. In this perspective we advocate for the participation of SCI specialists in this process, where the expertise and perspective on this disorder and requirements for the diagnostic and therapeutic work up is well developed.</jats:p>
2Scopus© Citations 18

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