Prevalence of physical signs in cervical myelopathy: a prospective, controlled study.
METHODS
Prospective case-control study.


OBJECTIVE
To determine the prevalence and utility of commonly tested myelopathic signs in surgically treated patients with cervical myelopathy (CM).


BACKGROUND
Although physical signs are sought in making the diagnosis of CM, their importance remains unclear, as patients with CM may have normal examinations while those without CM can demonstrate "myelopathic" signs.


METHODS
Patients presenting with cervical complaints and advanced imaging were evaluated over a 6-month interval in a single surgical practice. The CM group consisted of those with (1) a history of myelopathic symptoms and (2) correlative spinal cord compression on imaging, who then (3) underwent surgery and (4) improved Nurick score by > or = 1 grade after surgery. The controls consisted of patients with neck/radicular complaints but no myelopathic symptoms and no cord compression on imaging. Myelopathic signs included hyperreflexia or provocative signs (Hoffman inverted brachioradialis reflex, clonus, Babinski).


RESULTS
There were 39 CM patients and 37 controls. Myelopathic signs were more prevalent in the CM group (79% vs. 57%; P = 0.05), with significantly higher rates of all provocative signs but not hyperreflexia. Overall, myelopathic signs were not highly sensitive in diagnosing the presence of CM, as 21% of CM patients failed to demonstrate any myelopathic signs. There was no correlation between the presence of myelopathic signs and diabetes or preoperative Nurick score. However, those with cord signal changes were significantly more likely to demonstrate myelopathic signs.


CONCLUSIONS
Although myelopathic signs are significantly more common in CM patients, they may be negative in approximately one-fifth and can not be relied on to make the diagnosis. In patients who lack myelopathic signs but otherwise seem myelopathic with no alternative explanations, symptoms combined with correlative imaging studies must be used to base treatment decisions, as the absence of signs does not preclude the diagnosis of myelopathy nor its successful surgical treatment.
Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Spine Center, 59 Executive Park South, Suite 3000, Atlanta, GA 30329, USA. john.rhee@emory.org
John M
JM
Rhee
John A
JA
Heflin
Takahiko
T
Hamasaki
Brett
B
Freedman
D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012021:Reflex, Abnormal; D001405:Reflex, Babinski; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D013118:Spinal Cord Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*