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

## TL;DR

This study identifies key symptoms and physical tests that help diagnose degenerative cervical myelopathy more accurately.

## Contribution

The study provides new evidence on the diagnostic utility of specific symptoms and physical assessments for degenerative cervical myelopathy.

## Key findings

- Neck pain, upper extremity numbness, and hand clumsiness are key distinguishing symptoms of DCM.
- The mJOA questionnaire showed the highest diagnostic utility among patient-reported outcome measures.
- Physical tests like UE reflexes and manual motor testing are useful for confirming DCM diagnosis.

## 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.

The online version contains supplementary material available at 10.1038/s41598-025-20928-4.