Healthcare provider perspectives of various signs and symptoms for diagnosing degenerative cervical myelopathy: Results of an international, multidisciplinary survey

Why This Matters

Degenerative cervical myelopathy (DCM) is frequently underdiagnosed, with delays of 1–4 years not uncommon. These delays can lead to irreversible neurologic decline. One major barrier is the lack of clear, widely adopted screening criteria. This study helps define which clinical signs and symptoms providers should prioritize when evaluating patients for DCM.

What the Research Found

This international survey gathered expert input across disciplines to identify which clinical features are most valuable for diagnosing DCM. Signs and symptoms were ranked on a 0–10 scale, with ≥6.5 considered clinically significant.

Key Findings:

  • 27 clinical features (15 symptoms, 12 signs) were identified as diagnostically important
  • Most highly ranked symptoms involved:
    • Hand dysfunction (loss of dexterity, clumsiness)
    • Upper extremity symptoms
    • Gait disturbance
  • Top-ranked clinical signs included:
    • Pathologic reflexes
    • Motor weakness
    • Coordination deficits
    • Gait abnormalities
  • Findings were consistent across specialties, experience levels, and geographic regions
  • Results will inform development of a standardized screening toolkit for early detection

Clinical Takeaways

    • Recognize that DCM often presents with subtle but progressive neurologic signs—especially involving the hands and gait
    • Be aware that hand dysfunction and gait changes are among the most important early clinical indicators
    • Consider incorporating screening for coordination, reflexes, and fine motor control in patients with neck-related complaints
    • Maintain a higher index of suspicion in patients with bilateral or multi-limb symptoms
    • Early identification and referral are critical to prevent irreversible neurologic decline

Where Collaborative Spine Care May Support This

Manual medicine providers, including chiropractors and other frontline clinicians, are often among the first to evaluate patients with neck and upper extremity complaints. Their role in early recognition of neurologic signs—such as gait changes, coordination deficits, and hand dysfunction—may be critical in identifying patients who require further evaluation and referral.

Reference

Burn LA, Rujeedawa T, Lalkhen A, et al. Healthcare provider perspectives of various signs and symptoms for diagnosing degenerative cervical myelopathy: Results of an international, multidisciplinary survey. Muscle & Nerve. 2025.
DOI: http://dx.doi.org/10.1002/mus.70068
PubMed: https://pubmed.ncbi.nlm.nih.gov/41334975/