The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis
Journal
Global Spine Journal
ISSN
2192-5682
2192-5690
Date Issued
2023
Author(s)
Zhilin Jiang
Benjamin Davies
Carl Zipser
Konstantinos Margetis
Allan Martin
Stavros Matsoukas
Freschta Zipser-Mohammadzada
Najmeh Kheram
Andrea Boraschi
Elina Zakin
Oke Righteous Obadaseraye
Michael G. Fehlings
Jamie Wilson
Chad E Cook
Jamie Milligan
Julia Tabrah
Shirley Widdop
Lianne Wood
Elizabeth A. Roberts
Tanzil Rujeedawa
Lindsay Tetreault
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<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>
Cite this document
Jiang, Z., Davies, B., Zipser, C., Margetis, K., Martin, A., Matsoukas, S., Zipser-Mohammadzada, F., Kheram, N., Boraschi, A., Zakin, E., Obadaseraye, O. R., Fehlings, M. G., Wilson, J., Yurac, R., Cook, C. E., Milligan, J., Tabrah, J., Widdop, S., Wood, L., … AO Spine RECODE-DCM Diagnostic Criteria Incubator. (2024). The value of clinical signs in the diagnosis of degenerative cervical myelopathy—A systematic review and meta-analysis. Global Spine Journal, 14(4), 1369-1394. https://doi.org/10.1177/21925682231209869
Subjects
cervical
;
degenerative disc disease
;
myelopathy
;
brachioradialis muscle
;
cervical disk degeneration
;
cervical myelopathy
;
cervical spondylosis
;
controlled study
;
dermatome
;
diagnostic test accuracy study
;
disease severity
;
gait disorder
;
human
;
hyperreflexia
;
imaging
;
intervertebral disk hernia
;
meta analysis
;
muscle hypertonia
;
neck pain
;
neuroimaging
;
nuclear magnetic resonance imaging
;
outcome assessment
;
predictive value
;
prevalence
;
review
;
risk assessment
;
sensitivity and specificity
;
somatosensory disorder
;
spinal cord compression
;
spinal cord injury
;
subluxation
;
systematic review
;
vibration sense