This is a retrospective, unblinded study of 120 patients without comorbidities undergoing laminoplasty for cervical myelopathy, defined as increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI).
On physical examination, the most sensitive findings were:
- Hyperreflexia of knee 94%
- Hoffmann reflex (“flexion of the ipsilateral thumb and/or index finger was considered as positive”) 81%
- Babinski sign 53%
- Ankle clonus 35%
These results are likely inflated due to lack of control group which prevented blinding. In addition, the authors noted that the signs were less sensitive in patients with mild disability. Regardless, I suspect the relative values of the signs are correct and I was surprised on the value of the Hoffmann reflex.
Chikuda H, Seichi A, Takeshita K, Shoda N, Ono T, Matsudaira K, Kawaguchi H, & Nakamura K (2010). Correlation between pyramidal signs and the severity of cervical myelopathy. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 19 (10), 1684-9 PMID: 20229121