Abstract
COMPARATIVE STUDY OF THE HOFFMANN?S SIGN AND INVERTED RADIAL REFLEX IN THE DIAGNOSIS OF PATIENTS WITH COMPRESSIVE CERVICAL MYELOPATHY

Alok Dahal, MS, ATM Mosharef Hossain, MS, Rani Gupta Sah, Phd and Rajesh Prasad Sah*, MS

ABSTRACT

Background: Cervical cord compressive myelopathy (CCCM) is characterized by spinal cord compression due to physiologic narrowing of the sagittal diameter of the spinal canal secondary to congenital and degenerative changes in the cervical spine. It’s clinical diagnosis is based largely on initial examination findings during a clinical screening, followed by imaging verification of cord injury or compression. There are contradictory reports regarding the clinical significance of Hoffmann’s sign and Inverted Radial Reflex (IRR) with the MRI findings consistent with compressive cervical myelopathy. The present study endeavored to produce the significance and association of the Hoffmann’s sign and Inverted Radial Reflex for a sample of patients using a clinical diagnosis and Imaging confirmation as the reference standard for compressive cervical myelopathy. Objectives: The objective of this study was to determine the significance and association of Hoffmann’s Sign and Inverted Radial Reflex for the diagnosis of compressive Cervical Myelopathy. Methods: A total of 50 (Mean age: 44.74, range 10-80 years) patients were recruited with the clinical diagnosis of compressive cervical myelopathy irrespective of age, sex and occupation admitted for surgery in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Results: The Sensitivity and accuracy of Hoffmann’s Test reported from our study was 75.6% and 76% respectively whereas, Sensitivity and accuracy of of IRR was 68.9% and 70%, respectively. There was a significant association between the Hoffmann’s sign and the MRI findings of compressive cervical myelopathy seen in MRI of cervical spine (P = 0.010). Similar, association was also found between Inverted Radial Reflex and the MRI findings of cervical spine, P= 0.031. The strength of agreement between the Hoffmann’s sign and the MRI findings showed fair correlation with kappa value of 0.294. The Kappa test also revealed the fair agreement between the inverted radial reflex and MRI findings of compressive cervical myelopathy with K-value 0.227. Conclusion: This study reported Hoffmann’s sign and inverted radial reflex as an essential diagnostic tool to rule in and rule out compressive cervical myelopathy. In comparison of two tests, Hoffmann’s sign was more sensitive, efficacious and strongly associated with MRI findings compared to IRR. MRI may not be essential for clinical diagnosis, however, MRI have major contribution during planning of surgery.

Keywords: Hoffmann’s sign, Inverted Radial Reflex, Compressive Cervical Myelopathy, Magnetic Resonance Imaging.


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