Introduction: Degenerative cervical myelopathy (DCM) is a common, debilitating, and treatable condition due to compression of the cervical spinal cord. Initial symptoms are often subtle or intermittent, often leading to delays in diagnosis and treatment that may increase lifelong disability. Currently, there are no published diagnostic criteria, contributing to substantial variability in both clinical practice and inclusion criteria in research studies. In this study, we aimed to assess an array of clinical symptoms and signs for the purpose of informing the development of diagnostic criteria and identifying early markers of DCM.
Methods: A prospective cohort study was conducted with extensive data collection including demographics, medical history, symptom history, mJOA, NDI, QuickDASH, EQ-5D-5L, EQ-VAS, power testing in 22 myotomes, JAMAR grip dynamometer, 1-2, 1-5, and 2-3 digit pinch dynamometer, sensory testing, GRASSP-Myelopathy, Berg Balance, and quantitative gait and balance testing using an electronic pressure mat.
Results: 60 DCM patients and 60 healthy subjects were enrolled. 216/281 (77%) outcome measures showed differences between DCM and healthy subjects (p < 0.05). The most significant objective measures were motor outcomes with UE Motor (1.44E-67), LE Motor (5.47E-35), Intrinsic Hand (FPL, Fab, Fad, 1D1, Opposition) (6.12E-41), and Jamar Hand Grip (8.4E-8). Pinprick (1.4E-22) was more sensitive than light touch (3.9E-15), vibration (3.1E-7) and proprioception (2.29E-4). Only special reflexes (1.98E-7) such as Inverted Brachioradialis, Tromners, Hoffman and Babinski significantly differed. Significant differences amongst subjective measures included NDI (3.7E-11), mJOA (8.2E-11) and EQD-5D-5L (4.25E-12). For symptom history, severity of gait imbalance (1.28E-10), hand incoordination (7.9E-9), weakness (6E-39), numbness (1.3E-2 1) and neck pain (5.38E-8) were most significant. For balance and gait, Berg Balance (2.1E-6) and scored assessment of wobbles (visible trunk corrections) standing on 1 foot (6.8E-8), tandem stance (3.37E-7) and tandem gait (8.8E-8) significantly differed.
Conclusion : This study identified numerous symptoms and signs that accurately separate DCM from healthy subjects. These data should inform the development of formal diagnostic criteria for DCM to address the substantial variability in clinical practice and research.
How to Improve Patient Care: Subjective measures and questionnaires utilized by CPG’s are unable to detect distinctions between suspected DCM and control groups, highlighting the importance of updated standardized diagnostic criteria and objective measures.
