BACKGROUND: Cervical radiculopathy (CR) is a common clinical presentation. The Spurling test is a commonly used provocative test for diagnosing cervical radiculopathy. Various diagnostic accuracy studies on the validity of the Spurling test have demonstrated high specificity but variable sensitivity.
OBJECTIVE: This study aimed to find an evidence-based explanation for the variation in sensitivity of the Spurling test to assess the value of the Spurling test for clinical practice.
STUDY DESIGN: A review of studies on the diagnostic validity of the Spurling test was conducted. The study sample comprised eight diagnostic accuracy studies of the Spurling test.
OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios are presented.
METHODS: A literature search of MEDLINE, EMBAS and PubMed was conducted through April 2022. The methodological quality of the studies was evaluated by Quality Assessment of Diagnostic Accuracy Studies (QUADAS).
RESULTS: Eight diagnostic accuracy studies were selected, showing high specificity ranging from 74% to 98.5%, and the sensitivity varied from 14.7% to 95%. Studies that recruited surgical candidates showed a higher sensitivity, ranging from 92% to 95%. Studies that adopted the modified Spurling test maneuvres (incorporating neck extension, head rotation, and lateral neck bending) revealed a slightly higher sensitivity than those using only the lateral neck bending maneuvre. The inherent flaws of the reference standards may have altered the validity of the Spurling test.
CONCLUSIONS: The value of the studies on the validity of the Spurling test has been undermined by multiple areas causing bias, such as patient spectrum difference, index test interpretation controversy, and a lack of gold reference standards. Spurling test use in clinical practice should be combined with patient history, careful selection of different Spurling variants, and other provocative tests to increase the diagnostic accuracy. Large-sample-size and well-validated studies on the accuracy of the Spurling test in diagnosing cervical radiculopathy are needed.