title: Neurologic level diagnosis of cervical stenotic myelopathy.
abstract: METHODS
  A cross-sectional analysis.
  
  
  OBJECTIVE
  To elucidate the accuracy of neurologic level diagnosis of cervical stenotic myelopathy.
  
  
  BACKGROUND
  Neurologic level diagnosis in cervical myelopathy has not been well established.
  
  
  METHODS
  A total of 106 patients with cervical stenotic myelopathy, with a single-level intramedullary high-intensity area confirmed on both preoperative and postoperative T2-weighted magnetic resonance imaging (MRI), were included in this study. We performed a level diagnosis on the basis of neurologic signs (the uppermost muscle with weakness, diminished or exaggerated deep tendon reflex, the uppermost level of sensory disturbance of the upper extremities) and compared it with a level diagnosis made by T2-weighted MRI. The sensitivity, specificity, and accuracy of neurologic signs on our index corresponding to each intervertebral level were calculated.
  
  
  RESULTS
  The averages of sensitivity, specificity, and accuracy were 42%, 80%, and 70%, respectively, in the uppermost muscle with weakness, 66%, 89%, and 83% in deep tendon reflex, and 74%, 91%, and 87% in the sensory disturbance area. The positive and negative predictive values were 40% and 91%, respectively, in the uppermost muscle with weakness, 66% and 89% in deep tendon reflex, and 74% and 91% in the sensory disturbance area. Accuracy of a diagnosis based on muscle weakness was less high, the reason being that in many patients, the uppermost muscle with weakness was extensor digiti communis or the intrinsic muscles of the hands, and this led to a lower sensitivity.
  
  
  CONCLUSIONS
  The average accuracy of neurologic level diagnosis based on the index we proposed was > or =70%. The level diagnosis by a sensory disturbance area showed the highest accuracy (87%).
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. seichi-ort@h.u-tokyo.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Ko
authors.initials: K
authors.lastname: Matsudaira
authors.forename: Akiro
authors.initials: A
authors.lastname: Higashikawa
authors.forename: Naoshi
authors.initials: N
authors.lastname: Ogata
authors.forename: Kozo
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D003251:Constriction, Pathologic; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012026:Reflex, Stretch; D012678:Sensation Disorders / Q000209:etiology; D012680:Sensitivity and Specificity; D013118:Spinal Cord Diseases / Q000150:complications* / Q000175:diagnosis*