title: Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy.
abstract: METHODS
  This was a retrospective study.
  
  
  OBJECTIVE
  The purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging.
  
  
  BACKGROUND
  Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord.
  
  
  METHODS
  Forty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy.
  
  
  RESULTS
  The most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score.
  
  
  CONCLUSIONS
  In patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy.
authors.affiliation: Neurosurgical Department, Faculty of Medicine, Menoufia University Hospital, Menoufia University, Menoufia, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Elnoamany
keywords: Cervical myelopathy; Increased signal intensity in magnetic resonance images; Pyramidal signs