Aims
Degenerative cervical myelopathy (DCM), a leading cause of chronic, non-traumatic spinal cord dysfunction, presents with diverse clinical presentations. Hence, the aim of this scoping review is to identify the clinical signs and symptoms in DCM patients that demonstrate high diagnostic accuracy.
Methods
Articles up to June 2024 were retrieved from PubMed, EMBASE, and Cochrane databases using search terms like "degenerative cervical myelopathy," "cervical spondylotic myelopathy," and related clinical signs and symptoms. Diagnostic accuracy terms such as "sensitivity" and "specificity" were included, excluding imaging techniques. Studies were screened based on selection criteria assessing the sensitivity and specificity of clinical signs or symptoms using an appropriate control group.
Results
A total of 297 articles were identified, with 16 deemed eligible for inclusion after screening and evaluation. The most sensitive clinical signs were Tromner sign (93-97%) and hyperreflexia (15-85%). The most specific signs were Babinski sign (93-100%), Tromner sign (79-100%), clonus (96-99%), and inverted supinator sign (78-99%). Neck pain had a sensitivity range of 76-94% and specificity of 11-73%. Hand incoordination showed 52% sensitivity and 92% specificity. Altered hand sensation had 76% sensitivity and 90% specificity. Upper extremity weakness had 51-75% sensitivity and 18-95% specificity. Gait imbalance exhibited 56-63% sensitivity and 52-95% specificity.
Conclusion
Highly sensitive signs like the Tromner sign and hyperreflexia can be used for screening, while specific signs such as Babinski, clonus, and the inverted supinator sign are recommended for confirmation. Symptoms like neck pain, hand incoordination, and altered hand sensation should heighten suspicion and guide differential diagnosis. Early and accurate diagnosis using these indicators can improve patient outcomes and reduce diagnostic delays.