{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T15:58:03Z","timestamp":1780934283601,"version":"3.54.1"},"reference-count":81,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Prospective cross-sectional observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to develop a novel Physical Performance Test (PPT)-based scoring system by linking PPTs with the radiological severity of Degenerative Cervical Myelopathy (DCM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The severity of spinal cord compression in DCM patients was assessed using the cross-sectional area (CSA) at the maximal stenosis, as determined by magnetic resonance imaging (MRI). Functional performance was evaluated with the modified JOA scoring system (mJOA) and PPTs: 10-second-Grip-and-Release-Test (GR), Simple-Foot-Tapping-Test (FTT), 10-second-Step-Test (SST), Nine-hole-Peg-Test (HPT), and 30-meter-Walking-Test (30MWT). Validity was determined by examining correlations between CSA and these metrics, using Pearson\u2019s correlation. The Hong Kong Myelopathy Criteria (HKMC) were developed through Principal Component Analysis and K-means clustering to combine PPTs with the highest correlation with CSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      269 DCM patients (57% female, mean age 63 \u00b1 9) were studied. 55% had CSA less than 70\u00a0mm\n                      <jats:sup>2<\/jats:sup>\n                      (mean CSA 55.92 \u00b1 7.37\u00a0mm\n                      <jats:sup>2<\/jats:sup>\n                      ), symptoms for 19 \u00b1 6 months, and mJOA of 14.4 \u00b1 2.0. PPTs showed significant correlations with CSA (r = \u22120.473 to 0.837,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), but not with mJOA. The HKMC, combining GR, FTT, and SST (loadings &gt;0.87), with a four-tier scoring system (0-3), showed a strong correlation (r = 0.896,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). A cutoff of 4.5 effectively indicates significant cervical stenosis, with 90% sensitivity and 94% specificity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study is the first to demonstrate a strong association between spinal cord compression and physical performance in DCM. As a novel DCM-specific assessment tool, the HKMC demonstrates bedside utility and superior validity compared to individual PPTs and mJOA to identify individuals with radiologically severe DCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251407649","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T16:08:08Z","timestamp":1766592488000},"page":"2394-2409","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Utilizing a Novel Combinatorial Physical Performance Test-Based Clinical Assessment Tool to Screen for Radiologically Severe Degenerative Cervical Myelopathy"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8922-4603","authenticated-orcid":false,"given":"Karlen Ka Pui","family":"Law","sequence":"first","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9958-3044","authenticated-orcid":false,"given":"Kenney Ki Lee","family":"Lau","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3480-371X","authenticated-orcid":false,"given":"Graham Ka Hon","family":"Shea","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8304-0419","authenticated-orcid":false,"given":"Kenneth Man Chee","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"},{"name":"The University of Hong Kong-Shenzhen Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2024.1254600"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217703089"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0207709"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-060689"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-016-4660-8"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182672307"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-013-0381-6"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0303-0"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0b013e3182a7f2c3"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.2196\/58802"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682231209869"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-022-07349-x"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-023-00983-3"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2010.1504"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjno-2024-000913"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200109010-00014"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231179030"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10489-023-04829-5"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.22603\/ssrr.2023-0104"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12092108"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1212\/cpj.0000000000200126"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2025.111297"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.5455\/ijhrs.0000000137"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/SMJ.0000000000000009"},{"issue":"2","key":"e_1_3_5_26_2","first-page":"11","article-title":"Objective and precise reliabilty of JOA scoring system for cervical spondylotic myelopathy","volume":"9","author":"Bai YB","year":"2005","unstructured":"Bai YB, Wang Y, Xiao SH, Zhang YG, Liu ZSWJ. 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