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Diagnostic performance of spurling's test for the assessment sub-acute and chronic cervical radiculopathy: a systematic review and meta-analysis

Lin LH, Lin TY, Chang KV, Tzang CC, Wu WT, Ozcakar L

Am J Phys Med Rehabil 2025 Feb 4;Epub ahead of print

systematic review

OBJECTIVE: Spurling's test (ST) is commonly used to diagnose cervical radiculopathy (CR); however, its diagnostic accuracy varies across studies. This systematic review and meta analysis aim to evaluate the diagnostic performance of ST for CR. DESIGN: A systematic search of PubMed, ClinicalTrials.gov, Cochrane Library, and Physiotherapy Database was conducted following PRISMA guidelines. Studies assessing ST against imaging or electrodiagnostic tests were included. A bivariate random-effects model calculated pooled sensitivity, specificity, likelihood ratios (LR), and log diagnostic odds ratios. RESULTS: Eight studies met the inclusion criteria. The pooled sensitivity of ST was 0.53 (95% confidence interval [CI]: 0.29 to 0.78), higher with imaging (0.67) than with electrodiagnostic testing (0.31). Combining neck rotation or extension increased sensitivity to 0.67, compared to 0.31 without. The pooled specificity was 0.92 (95% CI: 0.88 to 0.96), 0.93 with imaging and 0.91 with electrodiagnostic testing. The pooled positive LR was 3.28, negative LR was 0.28, and the log diagnostic odds ratio was 2.74. CONCLUSIONS: ST is highly specific but has low sensitivity for CR diagnosis, making it better suited for confirmation than screening. Sensitivity may improve with added maneuvers and imaging as a reference.

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