Diagnostic Performance of Spurling's Test for the Assessment Subacute and Chronic Cervical Radiculopathy: A Systematic Review and Meta-analysis.

Abstract

Spurling's test is commonly used to diagnose cervical radiculopathy (CR); however, its diagnostic accuracy varies across studies. This systematic review and meta-analysis aim to evaluate the diagnostic performance of Spurling's test for cervical radiculopathy. A systematic search of PubMed, ClinicalTrials.gov , Cochrane Library, and Physiotherapy Database was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies assessing Spurling's test against imaging or electrodiagnostic tests were included. A bivariate random-effects model calculated pooled sensitivity, specificity, likelihood ratios, and log diagnostic odds ratios. Eight studies met the inclusion criteria. The pooled sensitivity of Spurling's test was 0.53 (95% confidence interval: 0.29-0.78), higher with imaging (0.67) than with electrodiagnostic testing (0.31) as the reference standard. Combining neck rotation or extension increased sensitivity to 0.67, compared to 0.31 without. The pooled specificity was 0.92 (95% confidence interval: 0.88-0.96), 0.93 with imaging and 0.91 with electrodiagnostic testing as the reference standard. The pooled positive likelihood ratio was 3.28, negative likelihood ratio was 0.28, and the log diagnostic odds ratio was 2.74. Spurling's test is highly specific but has low sensitivity for cervical radiculopathy diagnosis, making it better suited for confirmation than screening. Sensitivity may improve with added maneuvers and imaging as a reference. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: 1) Understand the diagnostic performance of Spurling's test for cervical radiculopathy. 2) Identify strategies to improve diagnostic performance during clinical testing. 3) Recognize the clinical role of Spurling's Test in the diagnosis and management of cervical radiculopathy. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.