The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis
Zhilin Jiang, Benjamin M. Davies, Carl Moritz Zipser, Konstantinos Margetis, Allan R. Martin, Stavros Matsoukas, Freschta Zipser-Mohammadzada, Najmeh Kheram, Andrea Boraschi, Elina Zakin, Oke Righteous Obadaseraye, Michael G. Fehlings, Jamie Wilson, Ratko Yurac, Chad Cook, Jamie Milligan, Julia Tabrah, Shirley Widdop, Lianne Wood, Elizabeth A. Roberts, Tanzil Rujeedawa, Lindsay Tetreault, AO Spine RECODE-DCM Diagnostic Criteria Incubator
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.