title: An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression - A comparative clinical study.
abstract: OBJECTIVE
  This study aimed at determining the frequency of abnormal finger flexion, Hoffman's and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients.
  
  
  METHODS
  Patients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffman's and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed.
  
  
  RESULTS
  The frequency of the reflexes in healthy controls were finger flexion - 1%, Hoffman's - 0.3% and Babinski sign - 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression.
  
  
  CONCLUSIONS
  A combination of finger flexion, Hoffman's and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals.
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
authors.forename: M N
authors.initials: MN
authors.lastname: Tejus
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Radio-diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
authors.forename: Ananthakrishnan
authors.initials: A
authors.lastname: Ramesh
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
authors.forename: V R Roopesh
authors.initials: VR
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India.
authors.forename: Ved Prakash
authors.initials: VP
authors.lastname: Maurya
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India. Electronic address: vensmad@gmail.com.
authors.forename: Venkatesh S
authors.initials: VS
authors.lastname: Madhugiri
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D066193:Cervical Cord; D002574:Cervical Vertebrae; D005260:Female; D005385:Fingers; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012021:Reflex, Abnormal; D001405:Reflex, Babinski; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000503:physiopathology
keywords: Babinski sign; Finger flexion reflex; Hoffman's reflex; Myelopathy; Plantar reflex