Assessing the diagnostic accuracy of symptoms and signs of degenerative cervical myelopathy: A prospective study

Degenerative cervical myelopathy (DCM) is a clinical diagnosis based on history, physical exam, and imaging, but standardized criteria have not been established, contributing to diagnostic delays. We conducted a prospective study of DCM and healthy subjects that comprehensively evaluated symptoms, patient-reported and clinician-administered outcome measures, and physical assessments of motor and sensory function.Diagnostic utility was evaluated using Youden's Index (YI=sensitivity+specificity-1). 139 DCM patients and 108 age-matched healthy subjects were compared. Distinguishing symptoms included neck pain (YI=63%), upper extremity (UE) numbness (YI=57%), hand clumsiness (YI=50%), walking imbalance (YI=50%), and UE weakness (YI=46%). Questionnaires performed well including mJOA (YI=72%), NDI (YI=63%), and EQ-5D (YI=57%). Physical testing showed best results with UE reflexes (YI=54%), strength in 5 UE muscle groups (YI=53%), Berg Balance scale (YI=50%), self-paced walking velocity (YI=48%), and tandem gait assessment (YI=40%). Hand dexterity, strength dynamometry, and testing of 5 sensory modalities demonstrated poor diagnostic utility. Diagnosis of DCM is challenging, but key symptoms include neck pain, UE weakness, and those captured by the mJOA (particularly UE numbness, hand clumsiness, and walking imbalance). Physical testing of reflexes, manual motor testing, and gait/balance are useful to confirm the diagnosis. These findings offer guidance for clinicians and the development of diagnostic criteria.

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Publication Details

Journal
Scientific Reports
Published
2025-10-23
DOI
https://doi.org/10.1038/s41598-025-20928-4
Primary Topic
Cervical and Thoracic Myelopathy
Type
article
Field-Weighted Citation Impact
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article

Assessing the diagnostic accuracy of symptoms and signs of degenerative cervical myelopathy: A prospective study

Nádia F. Simões de Souza, Benjamin M. Davies, Lindsay Tetreault, Hai V Le et al.
Scientific Reports
Cervical and Thoracic Myelopathy
article

Assessing the diagnostic accuracy of symptoms and signs of degenerative cervical myelopathy: A prospective study

Nádia F. Simões de Souza, Benjamin M. Davies, Lindsay Tetreault, Hai V Le, Aria Nouri, Bizhan Aarabi, Yashar Javidan, Eric O. Klineberg, Tess Perez, Michael George Fehlings, Shekar N. Kurpad, Carl Moritz Zipser, Kee D. Kim, Safdar N. Khan, Richard L. Price, Allan R. Martin, Rolando Roberto, Sukhvinder Kalsi‐Ryan, Khadija Soufi, Omar Ortuno, Jose Castillo, Brian Kwon, Ting‐Hui Chu, Giselle Ghabussi
article en

Abstract

Degenerative cervical myelopathy (DCM) is a clinical diagnosis based on history, physical exam, and imaging, but standardized criteria have not been established, contributing to diagnostic delays. We conducted a prospective study of DCM and healthy subjects that comprehensively evaluated symptoms, patient-reported and clinician-administered outcome measures, and physical assessments of motor and sensory function.Diagnostic utility was evaluated using Youden's Index (YI=sensitivity+specificity-1). 139 DCM patients and 108 age-matched healthy subjects were compared. Distinguishing symptoms included neck pain (YI=63%), upper extremity (UE) numbness (YI=57%), hand clumsiness (YI=50%), walking imbalance (YI=50%), and UE weakness (YI=46%). Questionnaires performed well including mJOA (YI=72%), NDI (YI=63%), and EQ-5D (YI=57%). Physical testing showed best results with UE reflexes (YI=54%), strength in 5 UE muscle groups (YI=53%), Berg Balance scale (YI=50%), self-paced walking velocity (YI=48%), and tandem gait assessment (YI=40%). Hand dexterity, strength dynamometry, and testing of 5 sensory modalities demonstrated poor diagnostic utility. Diagnosis of DCM is challenging, but key symptoms include neck pain, UE weakness, and those captured by the mJOA (particularly UE numbness, hand clumsiness, and walking imbalance). Physical testing of reflexes, manual motor testing, and gait/balance are useful to confirm the diagnosis. These findings offer guidance for clinicians and the development of diagnostic criteria.

Scientific ReportsVol. 15(1)
Creighton University (US), Brigham and Women's Hospital (US), University Medical Center Groningen (NL), University of British Columbia (CA), University of Groningen (NL), University of Toronto (CA), Medical College of Wisconsin (US), Toronto Rehabilitation Institute (CA), Cambridge University Hospitals NHS Foundation Trust (GB), University of California System (US), Massachusetts General Hospital (US), Bridge University (SS), University Hospital of Zurich (CH), University Hospital of Geneva (CH), Universitätsklinik Balgrist (CH), The University of Texas Health Science Center (US), University of Maryland, College Park (US), University of California, Davis (US)
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