Table 4.
Summary of Studies That Included a Control Group and Assessed the Diagnostic Accuracy of Various Clinical Signs.
| Author (Year), Study Design, QUADAS-2 (Risk of Bias)∞ | Objective | Cervical Myelopathy and Control Group | Demographic Information | Clinical Signs | Metrics of Diagnostic Accuracy Assessed |
|---|---|---|---|---|---|
| Rhee et al (2009), prospective, 4 (moderate) | To determine the prevalence and utility of commonly tested myelopathic signs in surgically treated patients with cervical myelopathy |
Cervical myelopathy group (n = 39) - History of myelopathic symptoms (upper extremity clumsiness, gait instability, nondermatomal numbness or weakness) - Presence of correlative spinal cord compression on advanced imaging - Treated with surgical decompression - Postoperative improvement in the modified nurick score of at least 1 point Control group (n = 37) - Neck pain or radicular arm complaints - No myelopathic symptoms - No evidence of cervical cord compression on advanced imaging - No history of previous spine surgery |
Cervical myelopathy group (n = 39) Age: 58 years Men: 56% Cord signal change: 51% Nurick preoperative 2.6 Control group (n = 37) Age: 48 Men: 49% Cord signal change: 0% Nurick preoperative: N/A |
Hyperreflexia (biceps, triceps, brachioradialis, patella, achilles) Hoffmann Inverted brachioradialis Sustained clonus Babinski |
Sensitivity Specificity Positive and negative predictive value a Positive and negative likelihood ratio a |
| Cook et al (2010), prospective, 5 (moderate) | To produce a cluster of predictive clinical findings for a sample of patients with cervical myelopathy |
Cervical myelopathy group (n = 88) - Diagnosis made by careful consideration of presenting symptoms, physical examination and imaging findings^ Control group (n = 161) - Cervical spine pain or dysfunction without image evidence of cervical myelopathy^ |
Cervical myelopathy group (n = 88) Age: 56.9±12.5 Men: 54.5% NDI, % disability: 40.3±19.4% SF-12: 42.9±7 Control group (n = 161) Age: 53.3±15.6 Men: 46.6% NDI, % disability: 40.4±18.5% SF-12: 45.4±6.7 |
Hoffmann Clonus Babinski Gait deviation Hyperreflexia (biceps, quadriceps, achilles) Inverted supinator sign |
Sensitivity Specificity Positive and negative predictive value a positive and negative likelihood ratio |
| Cook et al (2009), prospective, 2 (low) | To assess reliability and diagnostic accuracy of neurological tests associated with cervical myelopathy |
Cervical myelopathy group (n = 18) - Cervical spine pain with signal intensity changes on MRI confirming the presence of myelomalacia Control group (n = 27) - Cervical spine pain without MRI evidence of myelomalacia |
Age: 52±13.4 Men: 41% |
Hoffmann Hyperreflexia of biceps or triceps Inverted supinator sign Suprapatellar quadriceps Hand withdrawal reflex Babinski Clonus |
Sensitivity Specificity Positive and negative predictive value a positive and negative likelihood ratio |
| Chaiyamongkol et al (2017), prospective, 5 (moderate) | To investigate the significance of the tromner sign and how its presence correlates with the severity of cervical myelopathy |
Cervical myelopathy group (n = 36) - Clinical symptoms and physical signs of cervical myelopathy, including loss of hand dexterity, gait dysfunction, motor/sensory dysfunction and long tract signs - Evidence of corresponding cervical cord compression Control group (n = 14) - Normal volunteers and patients seeking orthopedic care for non-spine related issues |
Cervical myelopathy group (n = 36) Age: 59±9.9 Men: 77.8% Control group (n = 14) Age: 53.5±10.3 Men: 21.4% |
Hoffmann Tromner Inverted radial reflex Babinski |
Sensitivity Specificity a Positive and negative predictive value Positive and negative likelihood ratio a |
| Chang et al (2011), prospective, 3 (low) | To evaluate and quantify the tromner sign and compare its parameters to the severity of cord compression in patients with cervical myelopathy |
Cervical myelopathy group (n = 46) - Sensory impairment, muscular weakness or associated hyperreflexia in upper and lower extremities - MRI evidence of cord compression Control group (n = 30) - Age matched healthy spouses of patients |
Not reported | Tromner Hoffmann |
Sensitivity Specificity a Positive and negative predictive value a Positive and negative likelihood ratio a |
| Harrop et al (2010), retrospective, 5 (moderate) | To correlate clinical findings of myelopathic signs to cervical MRI features of cord compression and parenchymal changes on T2-weighted images |
Cervical myelopathy group (n = 54) - Presence of >1 long tract sign localized to the cervical spine, including hoffmann, babinski, clonus, hyperreflexia, crossed abductor and gait dysfunction Control group (n = 49) - Referred for symptomatic cervical spine disease but without myelopathic signs |
Cervical myelopathy group (n = 54) Age: 56.9 Men: 44% Control group (n = 49) Age: 49.5 Men: 47% |
Gait abnormality Hyperreflexia (LE or UE) LE hyperreflexia UE hyperreflexia Babinski Hoffmann Cross-abductor Sensory loss |
Sensitivity Specificity b Positive and negative predictive value b |
| Cao et al (2019), retrospective, 3 (low) | To analyze the correlation between the hoffmann sign and cervical pathology in symptomatic patients; to calculate the sensitivity, specificity, and positive and negative predictive values of the hoffmann sign for cervical pathology |
Cervical myelopathy group (n = 86)& - Referred for complaints related to the cervical spine - Image evidence of spinal cord compression Control group (n = 21) - Referred for complaints related to the cervical spine - No image evidence of spinal cord compression |
Not reported | Hoffmann | Sensitivity Specificity Positive and negative predictive value Positive and negative likelihood ratio a |
| Glaser et al (2001), prospective, 2 (low) | To evaluate the hoffmann sign as a screening tool for radiographic evidence of cervical spinal cord compression |
Cervical myelopathy group (n = 48)& - Referred for complaints related to the cervical spine - Image evidence of spinal cord compression Control group (n = 76) - Referred for complaints related to the cervical spine - No image evidence of spinal cord compression |
Not reported | Hoffmann | Sensitivity Specificity Positive and negative predictive value Positive and negative likelihood ratio a |
| Grijalva et al (2015), retrospective, 6 (moderate) | To examine the relationship between hoffmann sign and cervical pathology in symptomatic patients |
Cervical myelopathy group (n = 53)& - Neck pain or radicular arm complaints - Image evidence of spinal cord compression Control group (n = 118) - Neck pain or radicular arm complaints - No image evidence of spinal cord compression |
Not reported | Hoffmann | Sensitivity Specificity Positive and negative predictive value Positive and negative likelihood ratio a |
| Archer et al (2020), retrospective analysis of prospective data, 9 (high) | To develop and validate prediction models for patient-reported disability, pain and myelopathy outcomes at 12 months in patients undergoing cervical spine surgery |
Cervical myelopathy group (n = 2641) - No definition Control group (n = 4988) - Cervical radiculopathy |
Cervical myelopathy group (n = 2641) Age: 60.4±11.4 Men: 53% Current smoker: 21% Baseline mJOA 12.4±2.8 Control group (n = 4988) Age: 54.6±11.0 Men: 50% Current smoker: 20% |
Motor deficit, undefined | Sensitivity Specificity a Positive and negative predictive value a Positive and negative likelihood ratio a |
| Phillips 1975, retrospective, 6 (moderate) | To assess clinical differences between patients with cervical spondylosis with brachial neuritis and those with cervical myelopathy |
Cervical myelopathy group (n = 151) - Not defined Control group (n = 50) - Cervical spondylosis with brachial neuritis - No involvement of the lower limbs (ie no long tract compression in the spinal cord) - Symptoms and signs confined to the neck, shoulder girdle and upper limb - Predominant feature being pain in the upper limb or brachial neuralgia |
Cervical myelopathy group (n = 151) Age: 57 Duration of symptoms: 2.15 years Control group (n = 50) Age: 47.5 Duration of symptoms: 2.7 years |
Motor impairment Sensory impairment Absence of deep tendon reflexes Weakness and wasting of shoulder girdle and deltoid muscles |
Sensitivity Specificity a |
N/A, not applicable; NDI, neck disability index; SF-12, Short Form 12; MRI, magnetic resonance imaging; LE, lower extremity; UE, upper extremity; mJOA, modified Japanese Orthopedic.
∞QUADAS-2 is scored out of 11. Low risk of bias = zero to 3, moderate risk of bias = 4 to 8 and high risk of bias = 9 to 11.
^Anterior-posterior width reduction, cross-sectional evidence of cord compression, obliteration of the subarachnoid space and signal intensity changes to the cord were considered the most important imaging parameters for confirmation of DCM.
aNot reported in study but calculated using control group.
bonly reported for sensory loss. It was assumed that patients with a combination of cervical spine complaints and image evidence of spinal cord compression had cervical myelopathy