Clustered clinical findings for diagnosis of cervical spine myelopathy.

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2010-12

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Abstract

Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann's test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio = 0.18; 95% CI = 0.12-0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio = 30.9; 95% CI = 5.5-181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations.

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10.1179/106698110x12804993427045

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Cook, Chad, Christopher Brown, Robert Isaacs, Matthew Roman, Samuel Davis and William Richardson (2010). Clustered clinical findings for diagnosis of cervical spine myelopathy. The Journal of manual & manipulative therapy, 18(4). pp. 175–180. 10.1179/106698110x12804993427045 Retrieved from https://hdl.handle.net/10161/31409.

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Brown

Christopher Robert Brown

Assistant Professor of Orthopaedic Surgery

As an orthopaedic specialist and spine surgeon, I am committed to providing the best possible outcome for my patients with the least invasive surgery possible. I treat patients using the latest minimally invasive surgical techniques. Among the conditions I see in my patients are cervical radiculopathy and myelopathy, and traumatic spine injuries. Among the procedures I perform are complex cervical reconstruction, disc replacement surgery, minimally invasive scoliosis surgery, motion preservation spine surgery, and metastatic and tumor surgery.


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