An overview of systematic reviews investigating the accuracy, reliability, and relationships of tests and measures for diagnosis of neck pain.

Background: Neck pain is a common condition and often difficult to differentiate and diagnose. Previous literature has investigated diagnostic accuracy of examination measures but is limited.

Objective: To investigate examination measures for diagnosis of neck pain.

Design: Umbrella review

Literature Search: Four databases were searched electronically. Quality and risk of bias were assessed using the AMSTAR 2 and ROBIS. Diagnostic criteria were investigated for accuracy, reliability, and relationship to neck pain diagnoses.

Study Selection Criteria: Systematic reviews of randomized clinical trials evaluating diagnostic criteria for neck pain.

Data Synthesis: Twenty seven systematic reviews were included. Quantitative and qualitative results were summarized in narrative format.

Results: Hand radiculopathy and numbness have good specificities (0.89-0.92) for facet and uncinate joint hypertrophy. The extension rotation test (ERT) and manual assessment have good sensitivities and moderate-good specificities. Positive ERT combined with positive manual assessment findings (+LR = 4.71; Sp = 0.83) improves diagnostic accuracy compared to a positive ERT alone (+LR = 2.01; Sp = 0.59). Canadian C-spine Rules and Nexus low-risk criteria have excellent validity in screening for cervical fracture or instability. Imaging appears to have validity in diagnosing ligamentous disruption or fractures, but lacks clarity on predicting future neck pain. Increased fatty infiltrates have been found with whiplash associated disorders and mechanical neck pain.

Conclusions: There are limited indicators providing strong diagnostic value for cervical spine diagnosis. Strength of recommendations are limited by heterogeneous outcomes, methodology, and classification systems. Future research should attempt to provide stronger recommendations of differential diagnostic criteria for pathoanatomical neck pain diagnoses.

背景：颈痛是一种常见病症，其鉴别与诊断常存在难度。既往已有文献对各类体格检查手段的诊断准确度展开了探索，但相关研究仍较为有限。
目的：探索用于颈痛诊断的体格检查手段。
研究设计：伞状综述（Umbrella review）
文献检索：通过电子检索4个数据库。采用AMSTAR 2（AMSTAR 2）与ROBIS（ROBIS）工具对研究质量及偏倚风险进行评估。针对诊断标准的准确度、可靠性及其与颈痛诊断的关联展开了分析。
研究纳入标准：纳入针对颈痛诊断标准开展评估的随机对照试验的系统评价。
数据综合：共纳入27篇系统评价。以叙述性综述的形式对定量与定性研究结果进行总结。
结果：手部神经根病（Hand radiculopathy）与麻木对关节突及钩椎关节肥大（Facet and uncinate joint hypertrophy）具有良好的特异度（0.89~0.92）。伸展旋转试验（Extension Rotation Test, ERT）与徒手体格检查均具有良好的灵敏度，且特异度处于中等至良好水平。相较于单独阳性伸展旋转试验结果（阳性似然比+LR=2.01，特异度Sp=0.59），联合阳性伸展旋转试验与阳性徒手体格检查结果（+LR=4.71，Sp=0.83）可提升诊断准确度。加拿大颈椎规则（Canadian C-spine Rules）与Nexus低危标准在筛查颈椎骨折或不稳方面具有极佳的效度。影像学检查在诊断韧带断裂或骨折方面具有一定效度，但在预测远期颈痛方面的价值尚不明确。挥鞭样相关疾病（Whiplash associated disorders）与机械性颈痛（Mechanical neck pain）患者可出现脂肪浸润增多的征象。
结论：目前可用于颈椎疾病诊断且具有较高诊断价值的指标仍较为有限。推荐意见的强度受研究结局异质性、研究方法与分类系统的限制。未来研究应致力于为病理解剖学颈痛（Pathoanatomical neck pain）诊断提供更具说服力的鉴别诊断标准推荐。