Neck pain with radiculopathy: A systematic review of classification systems

Background: Disparities in eligibility criteria for cervical radiculopathy (CR) in clinical trials have been acknowledged previously. The increasing use of CR related neck pain classification systems to inform eligibility criteria in clinical trials warrants evaluation. Objective: To evaluate existing neck pain classification systems for CR. Design: Systematic review and critical appraisal, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Methods: Database searches were performed from inception until 31/7/2020. Neck pain classification systems containing CR as a component were included. Methodological quality of each classification system was assessed using seven measurement property domains and scored using a framework developed by Buchbinder and colleagues. Classification criteria for CR from classification systems assessed as moderate or good quality were narratively synthesised using inductive content analysis which consisted of selecting unit of analysis, open coding, grouping and categorisation. Results: Out of 19,975 references, 14,893 remained after elimination of duplicates with 17 articles reporting 11 classification systems included. Five moderate and one good quality classification systems were identified. Nine classification criteria for CR were derived, including dermatomal sensory deficit, positive Spurling's test, positive upper limb tension test. Conclusion: All classification systems had methodological limitations with Childs et al. (2008) classification system identified as good quality and most clinically useful. Future studies should investigate the reliability of Childs et al. (2008) classification system as it has the potential to further strengthen its methodological quality and clinical utility. The nine derived classification criteria can inform eligibility criteria in future trials.