A Systematic Review of the Utility of the Hoffmann Sign for the Diagnosis of Degenerative Cervical Myelopathy

Fogarty, Alexandra E.; Lenza, Eric; Gupta, Gaurav; Jarzem, Peter; Dasgupta, Kaberi; Radhakrishna, Mohan

doi:10.1097/brs.0000000000002697

Cited by 13 publications

(6 citation statements)

References 25 publications

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“…The Hoffman sign has a prevalence of 2% in the general population, although a positive predictive value of 68% and negative predictive value of 70% for CSM make it a useful adjunct in diagnosis. 33,34 Sensory changes due to compression of the spinothalamic tract, posterior column, and spinal roots can lead to changes in pain, temperature, proprioception, and general dermatomal sensation. 7 Specific sensory findings in the upper extremity and thorax in patients with CSM include neck pain (50%), radicular pain (38%), and a positive Lhermitte sign (27%).…”

Section: Upper Extremity Findingsmentioning

confidence: 99%

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management

et al. 2020

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Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures. It is the most common form of spinal cord injury in adults; yet, its diagnosis is often delayed. The purpose of this article is to review the pathophysiology, natural history, diagnosis, and management of CSM with a focus on the recommended timeline for physicians suspecting CSM to refer patients to a spine surgeon. Various processes underlie spondylotic changes of the canal and are separated into static and dynamic factors. Not all patients with evidence of cord compression will present with symptoms, and the progression of disease varies by patient. The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction. magnetic resonance imaging is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications. Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively. Due to the long-term disability that may result from a delay in diagnosis and management, prompt referral to a spine surgeon is recommended for any patient suspected of having CSM. This review provides information and guidelines for practitioners to develop an actionable awareness of CSM.

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Section: Upper Extremity Findingsmentioning

confidence: 99%

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management

et al. 2020

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“…Database records containing ‘Degenerative Cervical Myelopathy’ in their title were searched and the results were filtered using the medline filter by publication type: systematic review. The results were sorted by year of publication and the top three systematic reviews that were not co‐authored by any of the co‐authors in this study were chosen for filter validation (Fogarty et al, 2018; Tetreault et al, 2016; Wang et al, 2019). A total of seventy‐seven references were identified from the systematic reviews, and their full texts were analysed to confirm eligibility.…”

Section: Methodsmentioning

confidence: 99%

Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy

Khan

Mowforth

Kuhn

et al. 2021

Health Info Libraries J

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Background: Degenerative cervical myelopathy (DCM) is a recently proposed umbrella term for symptomatic cervical spinal cord compression secondary to degeneration of the spine. Currently literature searching for DCM is challenged by the inconsistent uptake of the term 'DCM' with many overlapping keywords and numerous synonyms.Objectives: Here, we adapt our previous Ovid medline search filter for the Ovid embase database, to support comprehensive literature searching. Both embase and medline are recommended as a minimum for systematic reviews.Methods: References contained within embase identified in our prior study formed a 'development gold standard' reference database (N = 220). The search filter was adapted for embase and checked against the reference database. The filter was then validated against the 'validation gold standard'.Results: A direct translation was not possible, as medline indexing for DCM and the keywords search field were not available in embase. We also used the 'focus' function to improve precision. The resulting search filter has 100% sensitivity in testing. Discussion and Conclusion:We have developed a validated search filter capable of retrieving DCM references in embase with high sensitivity. In the absence of consistent terminology and indexing, this will support more efficient and robust evidence synthesis in the field.

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“…There are a few recent studies that have looked at the validity of upper extremity reflexes and Hoffman sign. In a systematic review of 201 patients presenting to spine specialists from three separate cross-sectional studies, Fogarty et al [24] reported the positive likelihood ratio (ie, likelihood that a patient with cervical myelopathy will test positive) of a positive Hoffman's sign for cervical myelopathy to range between 1.8 -6.0 with a combined value of 2.6 (95% CI 1.8-3.9) and a negative predictive value (ie, probability that a patient with a negative test does not have cervical myelopathy) of 70%. This represents only a modest contribution to the overall diagnostic picture of a patient with degenerative cervical myelopathy.…”

Section: Case For Cervical Spine Clearancementioning

confidence: 99%

A Retrospective Pilot Study for Preoperative Screening to Prevent Iatrogenic Cervical Spinal Cord Injury

Diaz¹,

Chin²,

Burks³

et al. 2021

Cureus

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Purpose: The preoperative medical clearance process is well established to screen for medical comorbidities and therefore must be thorough. However, screening for potential cervical spine disease is often overlooked. In older surgical candidates, the presence of cervical spondylosis can increase risk of iatrogenic cervical spine injury during prolonged neck extension in non-spinal surgeries. We present a standard protocol for cervical spine clearance and a novel sustained neck extension maneuver through a retrospective case series. Methods: Sixty-three consecutive cases that underwent preoperative cervical clearance between April 2012 and December 2019 were reviewed. Referral for clearance occurred through the department of anesthesiology after concerning radiographic or physical exam findings were noted. A standard preoperative screening protocol with a sustained one-minute neck extension maneuver was implemented. Recommendations were made for standard neck precautions with or without neuromonitoring or for cervical spine decompression surgery prior to the planned procedure. Results: There were 25 patients with symptoms of myelopathy, 11 with radiculopathy and 13 with neck pain at baseline. Cervical spondylosis was observed in 51 patients, cervical canal stenosis in 29 and cervical myelomalacia in six. Fifty-seven patients underwent neck extension exam and 25 exhibited new or worsening symptoms. Myelopathic symptoms and radicular pain at baseline and positive Hoffman’s and Spurling’s sign, independently, were significantly associated with a positive neck extension exam (p<0.05). Fourteen patients were recommended for cervical decompression prior to planned procedure. Conclusions: Our preoperative cervical spine clearance protocol is safe and may aid in identifying patients susceptible to iatrogenic cervical spine injury.

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A Systematic Review of the Utility of the Hoffmann Sign for the Diagnosis of Degenerative Cervical Myelopathy

Abstract: 1.

Cited by 13 publications

References 25 publications

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management

Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy

A Retrospective Pilot Study for Preoperative Screening to Prevent Iatrogenic Cervical Spinal Cord Injury

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