Soufi Khadija, Ortuno Omar, Castillo Jose A, de Souza Nádia F Simões, Perez Tess, Ghabussi Giselle, Chu Tiffany, Kim Kee D, Price Richard, Javidan Yashar, Le Hai V, Roberto Rolando F, Khan Safdar, Klineberg Eric O, Tetreault Lindsay, Davies Benjamin, Zipser Carl M, Nouri Aria, Kurpad Shekar, Aarabi Bizhan, Kwon Brian K, Kalsi-Ryan Sukhvinder, Fehlings Michael G, Martin Allan R
Spinal Cord Injury, Function, and Imaging (SCIFI) Laboratory, Department of Neurological Surgery, University of California, Davis, US.
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Sci Rep. 2025 Oct 23;15(1):37043. doi: 10.1038/s41598-025-20928-4.
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.
退行性颈椎脊髓病（DCM）是一种基于病史、体格检查和影像学检查的临床诊断，但尚未建立标准化的诊断标准，这导致了诊断延迟。我们对DCM患者和健康受试者进行了一项前瞻性研究，全面评估了症状、患者报告和临床医生实施的结局指标，以及运动和感觉功能的体格评估。使用约登指数（YI = 敏感度 + 特异度 - 1）评估诊断效用。比较了139例DCM患者和108例年龄匹配的健康受试者。具有鉴别诊断意义的症状包括颈部疼痛（YI = 63%）、上肢麻木（YI = 57%）、手部笨拙（YI = 50%）、行走不平衡（YI = 50%）和上肢无力（YI = 46%）。问卷调查表现良好，包括改良日本骨科协会评估问卷（mJOA，YI = 72%）、颈部残疾指数（NDI，YI = 63%）和欧洲五维健康量表（EQ - 5D，YI = 57%）。体格检查中，上肢反射（YI = 54%）、5组上肢肌肉力量（YI = 53%）、伯格平衡量表（YI = 50%）、自定步速行走速度（YI = 48%）和串联步态评估（YI = 40%）显示出最佳结果。手部灵活性、握力测定以及5种感觉模式的测试显示出较差的诊断效用。DCM的诊断具有挑战性，但关键症状包括颈部疼痛、上肢无力，以及mJOA所涵盖的症状（特别是上肢麻木、手部笨拙和行走不平衡）。反射的体格检查、手动运动测试以及步态/平衡测试有助于确诊。这些发现为临床医生和诊断标准的制定提供了指导。
