Improving the Diagnosis and Early Detection of Degenerative Cervical Myelopathy: A Prospective Cohort Study

Introduction: Degenerative cervical myelopathy (DCM) results from cervical spinal cord compression and there are no published diagnostic criteria. In this study, we aimed to assess an array of outcomes for the purpose of informing the development of diagnostic criteria.

Methods: A prospective cohort study was conducted with extensive data collection including demographics, medical/symptom history, mJOA, NDI, QuickDASH, EQ-5D-5L, EQ-VAS, power testing in 22 myotomes, JAMAR grip dynamometer, digit pinch dynamometer, sensory testing, GRASSP-Myelopathy, and quantitative gait and balance testing using an electronic pressure mat. Sensitivity (SN) and specificity (SP) were calculated for all outcome variables and top 10 symptoms/clinical signs were ranked by Youden’s index (SN + SP – 1).

Results: 130 DCM patients and 84 controls were enrolled. 216/281 (77%) outcome measures showed differences between DCM and healthy subjects (p < 0.05).
The ten most discriminative clinical symptoms included: neck pain (SN 81%, SP 73%), hand incoordination (SN 52%, SP 92%), altered hand sensation (SN 76%, SP 90%), upper extremity weakness (SN 51%, SP 95%), autonomic dysfunction (urinary/bowel/sexual dysfunction) (SN 24%, SP 95%), gait imbalance (SN 63%, SP 95%), limitations in daily activities (SN 77%, SP 92%), difficulty lifting heavy objects (SN 75%, SP 87%), and exacerbation of neck pain during driving (SN 70%, SP 90%) or reading (SN 71%, SP 78%).
Conversely, the 10 most discriminative clinical signs included: weakness in thumb opposition (SN 32%, SP 97%), 1st dorsal interosseus (SN 35%, SP 97%), and intrinsic hand strength deficits (SN 25%, SP 98%). Reflex abnormalities including, hyper-reflexia of the biceps (SN 61%, SP 74%), triceps (SN 40%, SP 92%) and Hoffman reflex (SN 89%, SP 41%) or Tromners reflex (SN 97%, SP 35%) were noted. Coordination testing, such as the presence of drops during the GRASSP-Myelopathy test, demonstrated SN 88% and SP 68%. Gait and balance measures included trunk deviations during tandem gait (SN 66%, SP 84%) and the ability to stand on one foot (SN 75%, SP 77%).

Conclusion : This study identified a 10 clinical symptoms and signs that differentiate individuals with DCM from their healthy counterparts which hold promise in contributing to the formulation of standardized diagnostic criteria for DCM.