Cervical Spondylotic Myelopathy Cluster | Spine Assessment

Cervical spondylotic myelopathy is the most common cause of atraumatic spinal cord injury in the elderly population. The main symptoms associated with cervical spondylotic myelopathy are gait abnormalities and weak or stiff legs of insidious onset. Furthermore, patients report clumsiness and reduced sensation in the hands. As the spinal cord gets compressed patients may also present with central cord symptoms such as spasticity and urinary retention. It can thus be a potentially devastating condition. 

Cook et al. (2010) produced a cluster of predictive clinical test findings for a sample of patients using a clinical diagnosis as the reference standard for CSM. The goal of the cluster is to detect the disease in stages or to rule out the condition during screening.

The five tests or patient characteristics included in the rule are the following:

1. Gait deviation: which shows as abnormally wide-based gait, ataxia, or spastic gait

2. A positive Hoffmann’s sign: This test is characterized by a reflex contraction of the thumb and index finger when flipping the distal part of the middle finger.

3. An inverted supinator sign: which is elicited by quick tapping near the styloid process of the radius, the attachment of the brachioradialis tendon. It shows in finger flexion or slight elbow extension.
4. A positive Babinski sign: This sign shows as extension of the big toe and fanning of the other four toes when stroking the lateral aspect of the foot sole from the heal forwards towards the great toe.
5. Age >45 years old

If 3/5 of the aforementioned characteristics are positive, the positive likelihood ratio for cervical spondylotic myelopathy is 30.9. If only one is positive the negative likelihood ratio is 0.18.

Cook, C., Brown, C., Isaacs, R., Roman, M., Davis, S., & Richardson, W. (2010). Clustered clinical findings for diagnosis of cervical spine myelopathy. Journal of Manual & Manipulative Therapy, 18(4), 175-180.