title: Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review.
abstract: OBJECTIVE
  The purpose of this review was to investigate the diagnostic accuracy for screening and confirmation of clinical tests for cervical spine myelopathy (CSM) and to investigate the quality of the studies that have investigated these values.
  
  
  METHODS
  This study was a systematic review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms for PubMed included myelopathy; diagnosis, differential; sensitivity and specificity; and physical examination. Search terms for Cumulative Index to Nursing and Allied Health Literature were limited to myelopathy and sensitivity and specificity. Qualitative assessment included report of diagnostic accuracy metrics (sensitivity, specificity, and positive and negative likelihood ratios) and quality scores using the Quality Assessment of Diagnostic Accuracy Studies tool. Scores were created for single tests and clustered test findings.
  
  
  RESULTS
  After evaluation, 12 full-text articles were selected, scored, and tabulated. Nearly all of the 18 tests demonstrated high levels of specificity and low levels of sensitivity, suggesting that they are poor screening tools. Only one study was scored as high quality. One study involved clustering of test findings but was considered low quality.
  
  
  CONCLUSIONS
  Nearly all of the clinical tests for CSM seem to be poor screening tools, which implies that manually oriented clinicians may perform treatment methods in a situation of doubt or uncertainly. More high-quality studies are needed, and manual therapists need to be cognizant that the current clinical tests for CSM lack strong diagnostic accuracy measures that are necessary for clinical decision making.
authors: Division of Physical Therapy, Walsh University, North Canton, OH 44720, USA. ccook@walsh.edu
authors: Chad E
authors: CE
authors: Cook
authors: Mark
authors: M
authors: Wilhelm
authors: Amy E
authors: AE
authors: Cook
authors: Christopher
authors: C
authors: Petrosino
authors: Robert
authors: R
authors: Isaacs
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology*; D019937:Diagnostic Techniques and Procedures / Q000592:standards; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009460:Neurologic Examination; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000473:pathology