Tremor as a symptom of degenerative cervical myelopathy: a systematic review

Abstract

Background

AO Spine RECODE-DCM (Research objectives and common data elements for degenerative cervical myelopathy) has highlighted that the subjective disability reported by people living with DCM is much broader than routinely considered today by most professionals. This includes a description of tremor. The objective of this review was to study the incidence and possible aetiology of tremor in degenerative cervical myelopathy (DCM).

Methods

A systematic review registered in PROSPERO (CRD42020176905) was conducted in Embase and MEDLINE for papers studying tremor and DCM published on or before the 20^th of July 2020. All manuscripts describing an association between tremor and DCM in humans were included. Articles relating to non-human animals, and those not available in English were excluded. An analysis was conducted in accordance with PRISMA and SWiM guidelines for systematic reviews.

Results

Out of a total of 4402 screened abstracts, we identified 7 case reports and series describing tremor in 9 DCM patients. Papers were divided into three groups for the discussion. The first group includes DCM correctly identified on presentation, with tremor as a described symptom. The second group includes cases where DCM was misdiagnosed, often as Parkinson’s disease. The third group includes a single case with a previous history of DCM, presenting with an otherwise unexplained tremor. This grouping allows for the clustering of cases supporting various arguments for the association between tremor and DCM.

Conclusion

DCM can be associated with tremor. The current evidence is restricted to case series. Further study is warranted to establish tremor prevalence, and its significance to assessment and management.

Keywords:

• Spinal cord diseases
• cervical vertebrae
• spondylosis
• spinal osteophytosis
• tremor
• dystonic disorders
• dyskinesias
• movement disorders

Disclosure statement

The authors have no conflicts of interest to declare.

Additional information

Funding

Research in the senior author’s laboratory is supported by the NIHR Biomedical Research Centre. MRK is supported by a National Institute for Health Research Clinician Scientist Award. This report is independent research arising from a Clinician Scientist Award, CS-2015-15-023, supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health and Social Care. BMD is supported by an NIHR Clinical Doctoral Fellowship. ODM is supported by an Academic Clinical Fellowship.