In the last few years, what we used to refer to as cervical spondylotic myelopathy (CSM) has been renamed to degenerative cervical myelopathy (DCM). DCM is a progressive spine condition which can present with subtle, non-specific symptoms in the upper and lower extremities, making diagnosis difficult. Existing evidence shows us that many of these patients see multiple health care providers, often over the course of many years, prior to getting an appropriate diagnosis. In practice, degenerative cervical myelopathy is often mistaken for carpal tunnel syndrome or cervical radiculopathy. This diagnostic delay can have significant consequences on patient quality of life and functional abilities.
Signs & Symptoms:
Typically, patients with DCM report symptoms including the upper and lower extremities such as bilateral arm paresthesia, reduced manual dexterity, gait instability and weakness. Other symptoms can include neck pain or stiffness, Lhermitte’s phenomena and urinary or fecal urgency or incontinence. In addition, patients typically present with a combination of upper and lower motor neuron signs such as abnormalities in their pain sensation, temperature, proprioception and/or vibration. Upper motor neuron signs typically include hyperreflexia below the level of the lesion, a positive Hoffmann sign, upgoing plantar responses, lower limb spasticity and corticospinal distribution motor deficits. Lower motor neuron signs can result from compression of the nerve roots as they exit the spinal canal and commonly include muscle atrophy, especially in the hands, muscle fasciculations and weakness.
This study:
Developing diagnostic criteria for degenerative cervical myelopathy will likely improve diagnosis and help reduce the diagnostic delay. The first step to creating these criteria is to identify signs that exhibit high sensitivity and specificity, as well as those that correlate with disease severity. Therefore, the objective of this systematic review is to assess the diagnostic accuracy of clinical signs of degenerative cervical myelopathy and evaluate their association with disease severity.
Comment from Dr. Thistle:
“DCM is a challenging and potentially serious condition that we should all be aware of in our aging patients. While the presence of clinical signs is helpful to make a diagnosis of DCM, examination findings may be absent entirely, especially early in the disease course. As a result, a lack of examination findings alone is not sufficient to exclude a diagnosis of degenerative cervical myelopathy and this diagnosis can still be made using a combination of patient reported symptoms and imaging findings. It is important to have a high index of suspicion for this condition and use a variety of clinical examination maneuvers to assess each patient.“
RESEARCH REVIEW: Clinical Signs for Diagnosing Degenerative Cervical Myelopathy
This paper was published in the Global Spine Journal (2023)
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