2023 American Academy of Neurology Abstract Website

Objective:

This systematic review aims to determine (i) the diagnostic accuracy and frequency of various clinical signs in patients with degenerative cervical myelopathy (DCM) and (ii) the association between clinical signs and disease severity.

Background:

Misdiagnosis or delayed diagnosis of DCM neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely improve diagnosis and facilitate earlier referral for definitive management. It is important to identify signs that exhibit high sensitivity and specificity, and those that are correlated with disease severity.

Design/Methods:

A systematic search was performed using MEDLINE. This review targeted studies on adult patients that evaluated the sensitivity, specificity, positive or negative predictive value or positive or negative likelihood ratios 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, as measured using an appropriate outcome instrument. 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. Based on the results of the eleven studies, the most sensitive clinical tests for diagnosing DCM are the Tromner (94%) and hyperreflexia (79%), while the most specific tests are the Babinski (99%), Tromner (93%), clonus (99%) and inverted supinator sign (93%). Five studies evaluated the association between the presence of various clinical signs and disease severity. Results were inconsistent across studies; no definite relationship was identified between disease severity and Hoffmann, Babinski or hyperreflexia.

Conclusions:

A combination of clinical signs is likely required to support a diagnosis of DCM as well as features from a patient’s history and imaging characteristics.