Handgrip Strength Testing in Degenerative Cervical Myelopathy: A Systematic Review and Meta-analysis

Introduction: Degenerative cervical myelopathy (CM), the leading cause of spinal cord dysfunction in older adults, often presents with hand clumsiness and weakness. Handgrip strength measurement via dynamometry provides a quantitative method to assess these deficits. Despite emerging evidence, the clinical relevance of handgrip strength in CM lacks a systematic review and meta-analysis.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed was searched up to November 2023 for studies measuring handgrip strength via dynamometry in CM patients. Data on study design, patient demographics, grip strength results, and associations with myelopathy severity or outcomes were extracted. Risk of bias was assessed using Cochrane tools. Pooled mean differences with 95% confidence intervals (CIs) were calculated.

Results: Twenty-five studies involving 3,270 patients (ages 31–69) met inclusion criteria. Fourteen studies reported reduced handgrip strength in CM patients compared to controls, with male values ranging from 12.5–33.55 kg and female values from 6.3–19.68 kg. Grip strength decreased with increasing myelopathy severity (p < 0.05). Meta-analysis of three studies showed CM patients had significantly lower grip strength than healthy controls (pooled mean difference: −3.73 kg; 95% CI: −6.54 to −0.92 kg; p = 0.0094; I² = 0%). Meta-analysis of four studies assessing preoperative and postoperative grip strength demonstrated a significant increase (pooled mean difference: +2.82 kg; 95% CI: +0.35 to +5.29 kg; p = 0.025; I² = 77.68%). Anterior cervical discectomy and fusion showed grip strength increases of 15–45%, while laminoplasty showed increases of 34–136%, correlating with improved postoperative functional scores.

Conclusion : Handgrip dynamometry quantitatively and objectively assesses hand dysfunction in degenerative cervical myelopathy. Reduced strength compared to controls indicates upper limb deficits, and associations with myelopathy severity and functional measures suggest that clinically relevant information can be obtained through grip testing. Improvements in grip strength after surgery support its use for treatment monitoring.