FPD203
Free Paper (Degenerative)
Utilizing a novel combinatorial Physical Performance Test-based clinical assessment tool to screen for radiologically severe Degenerative Cervical Myelopathy
*Karlen Ka Pui LAW, OT, MPhil1, Kenney Ki Lee LAU, BA, MSc, PhD, FRSPH1, Graham Ka Hon SHEA,
MBBS, PhD, FRCS (Ortho)1, Kenneth Man Chee CHEUNG, MBBS, EMBA, MD, FRCS, FHKCOS, FHKAM(Ortho)1, 2
1Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China 2Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
Background: Diagnosis of Degenerative Cervical Myelopathy (DCM) relies on Magnetic Resonance Imaging (MRI), which is often delayed due to long wait times and non-specific findings. The modified Japanese Orthopaedic Association Scoring System for Cervical Myelopathy (mJOA) lacks objectivity; combining performance tests such as the NIH Toolbox, grip and release test, and grip strength improves sensitivity for earlier detection.
Objective: This study aimed to develop a novel bedside Physical Performance Test (PPT)-based scoring system by linking PPTs to the radiological severity of DCM.
Study design: Prospective cross-sectional observational study
Methods: DCM severity was assessed by MRI, the cross-sectional area (CSA), while functional deficit was assessed by the mJOA and PPT (10-second Grip and Release Test (GR), Foot Tapping Test (FTT), 10-second Step Test (SST), Nine hole Peg Test (HPT), and 30 m Walking Test (30MWT). CSA correlations were analyzed, and the Hong Kong Myelopathy Criteria (HKMC) were developed via Principal Component Analysis and K-means Clustering.
Results: 269 DCM patients (57% female, mean age 63±9) were studied. 55% had CSA less than 70mm² (mean CSA 55.92±7.37mm²), symptoms for 19±6 months, and mJOA of 14.4±2.0. PPTs showed significant correlations with CSA (r = -0.473 to 0.837, p
< 0.001), but not with mJOA. The HKMC, combining GR, FTT, and SST (loadings > 0.87), with a four- tier scoring system (0-3) showed a strong correlation (r = 0.896, p < 0.001). A cutoff of 4.5 effectively indicates significant cervical stenosis, with 90% sensitivity and 94% specificity.
Conclusion: This study is the first to demonstrate a strong association among MRI evidence, the severity of spinal cord compression, and physical performance in DCM. As a novel DCM-specific assessment, the HKMC demonstrates bedside utility and superior validity compared with individual PPTs and mJOA for identifying individuals with radiologically severe DCM