title: Reliability and diagnostic accuracy of clinical special tests for myelopathy in patients seen for cervical dysfunction.
abstract: METHODS
  Case control study.
  
  
  BACKGROUND
  Myelopathy is a clinical diagnosis based largely on initial examination findings during a clinical screen, followed by imaging verification of cord injury or compression. At present, few studies have examined the reliability and diagnostic accuracy of clinical examination measures.
  
  
  OBJECTIVE
  To determine the reliability and diagnostic accuracy of neurological tests associated with the diagnosis of myelopathy.
  
  
  METHODS
  Reliability and diagnostic accuracy of 7 frequently used tests and measures and subjective findings associated with myelopathy were examined on consecutive patients with cervical pain. Interrater reliability and diagnostic accuracy values, including posttest probability, based on a pretest probability of 40%, were calculated for each test and for combinations of tests and measures.
  
  
  RESULTS
  Four of the 7 diagnostic tests were found to have a substantial interrater reliability. None of the single or clusters of tests yielded low negative likelihood ratios. Of the individual tests, the Babinski sign demonstrated the highest positive likelihood ratio (LR+, 4.0; 95% CI: 1.1-16.6) and posttest probability (73%) for diagnosis, but yielded only a moderate negative likelihood ratio (LR-, 0.7; 95% CI: 0.6-0.9). Combinations of tests did not yield improved accuracy values over single test results.
  
  
  CONCLUSIONS
  This study demonstrated that 4 of 7 tests used to screen for myelopathy offered substantial levels of interrater agreement when used on individuals with cervical dysfunction. None of the tests when performed individually or in combinations are effective for screening; however, the Babinski sign did alter posttest probability more significantly than combinations of test findings.
  
  
  METHODS
  Diagnosis, Level 2b.
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA. chad.cook@duke.edu
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: Matthew
authors.initials: M
authors.lastname: Roman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Stewart
authors.forename: Linda Gray
authors.initials: LG
authors.lastname: Leithe
authors.forename: Robert
authors.initials: R
authors.lastname: Isaacs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods*; D015203:Reproducibility of Results; D013118:Spinal Cord Diseases / Q000175:diagnosis*