Early Diagnosis of Degenerative Cervical Myelopathy: A Systematic Review of Current Evidence

Study DesignSystematic Review.ObjectivesDegenerative cervical myelopathy (DCM) or cervical spondylotic myelopathy (CSM) is a progressive neurological condition linked to cervical degeneration, often presenting with a wide range of symptoms that complicate diagnosis. This study aims to identify clinical, radiological, and electrophysiological measures that aid in early DCM diagnosis.MethodsFollowing PRISMA guidelines a systematic review was performed. Literature from PubMed, Scopus, and the Cochrane Library up to November 2025 was analyzed. Search terms included "degenerative cervical myelopathy", "cervical spondylotic myelopathy", "CSM", "Early clinical signs", "Diffusion Tensor Imaging", "Fractional anisotropy", "Motor-evoked potentials", "Sensory-evoked potentials". The included studies primarily focused on clinical examinations, radiological imaging, and electrophysiological tests to detect early signs of DCM.ResultsA total of 36 met the inclusion criteria, involving 4596 patients. Tests for "myelopathy hand" signs showed high negative predictive values in excluding DCM. Lower limb assessments, such as the ten-second step test and Rossolimo reflex, also showed promise for early diagnosis. Among imaging techniques, DTI outperformed traditional T2-weighted Magnetic Resonance Imaging (MRI) in sensitivity, specificity, and predictive value. Kinematic CT myelography (CMCT) also demonstrated potential for early detection. Electrophysiological tests, including SEPs and MEPs, provided valuable insights into disease severity when performed both statically and dynamically.ConclusionsDCM's variable profile complicates diagnosis. This review highlights the importance of underused clinical evaluations for earlier detection, with DTI showing promise for early changes and preventive use. Electrophysiological measures, non-invasive and accurate, should be integrated alongside dynamic evaluations for a comprehensive, multi-modal diagnostic approach.