Clinical signs and symptoms for degenerative cervical myelopathy: a scoping review of case-control studies to facilitate early diagnosis among healthcare professionals with stakeholder engagement

Abstract

Scoping Review. Degenerative cervical myelopathy (DCM) is a leading cause of chronic spinal cord dysfunction, with diverse clinical presentations that complicate diagnosis. Therefore, it is important to identify the signs and symptoms of DCM that demonstrate high diagnostic accuracy. This review aims to evaluate the sensitivity and specificity of signs and symptoms in diagnosing DCM. Articles up to June 2024 were retrieved from PubMed, EMBASE, and Cochrane databases using search terms like “degenerative cervical myelopathy”, “cervical spondylotic myelopathy”, “sensitivity”, “specificity”, and related signs and symptoms. Studies were screened based on selection criteria assessing the sensitivity and specificity of signs or symptoms using an appropriate control group. Sixteen studies were included. The most sensitive signs were Tromner sign (93–97%) and hyperreflexia (15–85%). Specific signs included the Babinski sign (93–100%), Tromner sign (79–100%), clonus (96–99%), and inverted supinator sign (78–99%). Neck pain had a sensitivity 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. Sensitive signs like the Tromner sign and hyperreflexia are useful for screening, while specific signs such as Babinski, clonus, and the inverted supinator sign aid in confirmation of DCM. 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.