Epidemiological study of cervical cord compression and its clinical symptoms in community-dwelling residents

Screening for degenerative cervical myelopathy with the 10-second grip-and-release test using a smartphone and machine learning: A pilot study

Objective

Early detection and intervention are essential for the mitigation of degenerative cervical myelopathy (DCM). However, although several screening methods exist, they are difficult to understand for community-dwelling people, and the equipment required to set up the test environment is expensive. This study investigated the viability of a DCM-screening method based on the 10-second grip-and-release test using a machine learning algorithm and a smartphone equipped with a camera to facilitate a simple screening system.

Methods

Twenty-two participants comprising a group of DCM patients and 17 comprising a control group participated in this study. A spine surgeon diagnosed the presence of DCM. Patients performing the 10-second grip-and-release test were filmed, and the videos were analyzed. The probability of the presence of DCM was estimated using a support vector machine algorithm, and sensitivity, specificity, and area under the curve (AUC) were calculated. Two assessments of the correlation between estimated scores were conducted. The first used a random forest regression model and the Japanese Orthopaedic Association scores for cervical myelopathy (C-JOA). The second assessment used a different model, random forest regression, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

Results

The final classification model had a sensitivity of 90.9%, specificity of 88.2%, and AUC of 0.93. The correlations between each estimated score and the C-JOA and DASH scores were 0.79 and 0.67, respectively.

Conclusions

The proposed model could be a helpful screening tool for DCM as it showed excellent performance and high usability for community-dwelling people and non-spine surgeons.

Development of a Novel Diagnostic Support Tool for Degenerative Cervical Myelopathy Combining 10-s Grip and Release Test and Grip Strength: A Pilot Study

Early diagnosis of degenerative cervical myelopathy (DCM) is desirable, as delayed treatment can cause irreversible spinal cord injury and subsequent activity of daily living (ADL) impairment. We attempted to develop a straightforward and accurate diagnostic tool for DCM by combining the grip and release test (GRT) and grip strength. As a pilot study, we measured the GRT and grip strength of patients with DCM (n = 247) and a control group (n = 721). Receiver operating characteristic analysis was performed using the lower left and right. The Youden index was used to set cutoff values by sex and age group. The diagnostic performance of each test varied by sex and age, and a diagnostic support tool was created to determine any abnormal results in a test. The calculated M/F cutoff values for GRT were as follows: 40–59 years, 21/18; 60–69 years, 17/17; 70–79 years, 15/15; and 80–89 years, 11/12. The calculated M/F cutoff values for grip strength 32/20, 29/13, 21/15, and 19/10. When either GRT or grip strength was judged as positive, the overall sensitivity was 88.2%, specificity was 78.1%, positive likelihood ratio was 4.03, and the negative likelihood ratio was 0.15. This novel diagnostic support tool was superior to using GRT and grip strength alone in the early DCM diagnosis. Future research to obtain age- and sex-specific data is necessary to validate and further improve the tool.

Associations between clinical neck symptoms and various evaluations ofcervical intervertebral disc degeneration by magnetic resonance imaging

PURPOSE

Magnetic resonance imaging (MRI) is widely used to evaluate intervertebral disc degeneration. Recently, various evaluations of cervical disc degeneration using MRI have been conducted, but there is no gold standard. The purpose of this study was to compare the reproducibilities of previously reported classifications for evaluating cervical disc degeneration by MRI and their associations with clinical symptoms.

PARTICIPANTS AND METHODS

A total of 582 subjects underwent conventional MRI of the cervical spine. Disc degeneration was assessed in each intervertebral disc from C2/3 to C7/T1 using five different classifications: Matsumoto's grading system, Miyazaki's grading system, Nakashima's grading system, Jacobs' grading system, and Suzuki's grading system. MR images of 30 participants were used, and Cohen's kappa coefficient of agreement of each classification was calculated for intra-observer and inter-observer reliabilities. These five classifications of disc degeneration and changes of vertebral endplates were measured, and associations with clinical symptoms were assessed.

RESULTS

Kappa (κ) values of intra-observer agreement were higher for Jacobs' classification, whereas those of inter-observer agreement were higher for Nakashima's and Jacobs' classifications than for other classifications. The prevalences of neck pain and shoulder stiffness were 27.4% and 41.9%, respectively. There were no associations for any classifications of disc degeneration and Modic types with neck pain or shoulder stiffness. Only the presence of Schmorl's nodes was associated with neck pain.

CONCLUSION

At present, there is no specific classification for cervical disc degeneration associated with clinical symptoms. Vertebral endplate changes might be associated with clinical symptoms. It may be necessary to create a new classification for better reproducibility of the evaluation of cervical disc degeneration.