title: The Significance of the Trömner Sign in Cervical Spondylotic Myelopathy Patient.
abstract: METHODS
  This study is a diagnostic analysis.
  
  
  OBJECTIVE
  To investigate the diagnostic accuracy of Trömner sign in cervical spondylotic myelopathy (CSM), and how its presence correlates with the severity of myelopathy.
  
  
  BACKGROUND
  A clinical presentation of myelopathy corresponding with image findings is a current standard to diagnose CSM. Trömner sign is an alternative of well-known Hoffmann sign to detect CSM. Little is known about its diagnostic accuracy and how its presence correlates with the severity of CSM.
  
  
  METHODS
  Consecutive patients with clinical diagnosis of CSM and other cervical spondylosis-related problems were enrolled in either CSM group, cervical spondylotic radiculopathy group, or axial pain group. Normal volunteers and patients without spine-related issues were used as a control. All participants were examined for the presence of myelopathic signs. Magnetic resonance imaging studies of all participants were reviewed by a radiologist.
  
  
  RESULTS
  There were 85 participants included in the study. Diagnostic sensitivity was 76%, 94%, 76%, and 36% for Hoffmann sign, Trömner sign, inverted radial reflex, and Babinski sign, respectively. Trömner sign had relatively high sensitivity (95%) despite of mild degree of myelopathy. Negative predictive value was 60%, 85%, 59%, and 38% for Hoffmann sign, Trömner sign, inverted radial reflex, and Babinski sign, respectively. There were 63%-71% of patients in either axial pain group or cervical spondylotic radiculopathy group had positive Trömner sign. Most of CSM patients with cord signal changed had positive myelopathic sign. Regarding CSM patient without cord signal change, most of tests were negative except Trömner sign.
  
  
  CONCLUSIONS
  High sensitivity (94%) and relatively high negative predictive value (85%) for Trömner sign indicate the usefulness of Trömner sign in ruling out CSM. High incidence of positive Trömner sign in presymptomatic cervical cord compression patients suggests Trömner sign could have a useful role in early detection of presymptomatic patients.
authors.affiliation: Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Weera
authors.initials: W
authors.lastname: Chaiyamongkol
authors.forename: Teeranan
authors.initials: T
authors.lastname: Laohawiriyakamol
authors.forename: Boonsin
authors.initials: B
authors.lastname: Tangtrakulwanich
authors.forename: Pramot
authors.initials: P
authors.lastname: Tanutit
authors.forename: Piyawat
authors.initials: P
authors.lastname: Bintachitt
authors.forename: Koopong
authors.initials: K
authors.lastname: Siribumrungwong
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012018:Reflex; D013117:Spinal Cord Compression / Q000150:complications / Q000000981:diagnostic imaging; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*