Priority 11 from the Degenerative Cervical Myelopathy PSP

UNCERTAINTY: What are the main signs and symptoms that a patient with DCM presents with? What are the frequency, sensitivity, specificity and positive predictive value of symptoms and signs (clinical assessments) for DCM?  (JLA PSP Priority 11)
Overall ranking 11
JLA question ID 0097/11
Explanatory note The spinal cord carries neurons that are responsible for motor, sensory and autonomic function. The cervical spinal cord contains nerves that innervate the upper limb as well as descending and ascending tracts to and from the trunk and lower extremities. As such, compression of the cervical spinal cord can result in motor and sensory dysfunction of upper and lower extremities and bladder and bowel issues. Common symptoms include numb and clumsy hands, bilateral arm paresthesia, Lhermitte's phenomena, impaired gait, weakness and urge incontinence. Objective signs of myelopathy include hyperreflexia, clonus, positive Hoffman sign, up-going plantar responses, lower-limb spasticity, corticospinal distribution motor deficits, atrophy of intrinsic hand muscles, broad-based unstable gait and sensory loss. Previous studies have reported the frequency, sensitivity and specificity of various clinical assessments for DCM. However, no systematic reviews or guidelines were identified that summarized the most common signs and symptoms of DCM. This information would be useful to help primary care physicians and other specialists effectively diagnose patients with myelopathy. 

Primary studies have evaluated the sensitivity and specificity of signs and symptoms in DCM patients. However, no systematic reviews, scoping reviews or guidelines have been conducted to answer this question.

Health Research Classification System category Neurological
Extra information provided by this PSP
Original uncertainty examples

What are the main symptoms that patients present with?~ Most common symptom? ~ At what point would Babinski or ankle clonus be present?  ~ What symptom(s) are most reflective of DCM? ~ What is the prevalence of each commonly reported symptom; which symptom is most sensitive and specific?  ~ What physical exam has the highest specificity and sensitivity in detecting early DCM? ~ What the signs and symptoms of DCM with the greatest sensitivity and specificity?

Submitted by Spinal Surgeons x 22, Other healthcare professionals x 24, People with DCM and their supporters x 5
PSP information
PSP unique ID 0097
PSP name Degenerative Cervical Myelopathy
Total number of uncertainties identified by this PSP. 76  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 20 November 2019