Clustered Clinical Findings for Dx of Cervical Spine Myelopathy

  • Cervical spine myelopathy (CSM) has no single sign or symptom and can present with an array of clinical findings that can vary from patient to patient 
  • Clinical findings include neck stiffness, gait abnormalities including spasticity, weakness of the legs, radicular symptoms in upper extremities, and loss of dexterity.
  • Most tests, when used alone, have poor diagnostic utility and can lead to false negatives and on occasion, false positives. Clustering tests helps overcome inherent weaknesses in stand alone tests and can help mimic actual clinical decision making processes. 
  • The purpose of this study was to produce a cluster of predictive clinical findings for a sample patient using a clinical diagnosis as the reference standard. Findings may help with earlier diagnosis or help rule out CSM during screening.
  • A diagnosis of CSM is made through the combination of clinical exam and MRI
  • Predictive variables studied included gait abnormality, Babinski and Hoffman’s sign, Spurling’s test, cervical distraction test, inverted supinator sign, hyperreflexia of biceps, Achilles, and quadriceps, presence of clonus, and pain.
  • Patients with CSM were typically older, had a longer duration of symptoms, and higher BMI
  • The 5 variables that were retained after regression modeling were the inverted supinator sign, gait abnormalities, Hoffman’s and Babinksi test, and age > 45. 
  • 3 of 5 positive findings yielded a +LR of 30 with a posttest probability of 94%. </= 1 of 5 yielded a -LR < 0.5 indicating a high probability that the individual did not have CSM.