Early diagnosis of cervical spondylotic myelopathy. A useful clinical sign

This is a retrospective study of 67 patients, seen during a 4-year period, with cervical pathology requiring surgical correction. The purpose of this study was to evaluate the usefulness of a new physical finding (dynamic Hoffmann's sign) in diagnosing early cervical myelopathy or in suggesting a narrow cervical canal clinically. Hoffman's sign was checked with the head in neutral (static) and during multiple active full flexion to extension as tolerated by the patient (dynamic). Forty patients had negative Hoffman's signs, 20 had positive static Hoffman's signs, and 7 had positive dynamic Hoffman's signs. Canal measurements were made on eight randomly selected negative patients on both plain films and myelographic studies, and on the seven positive patients. A positive dynamic Hoffmann's sign was consistent with a narrow sagittal diameter of the cervical canal, and aided clinically in making the diagnosis of early cervical spondylotic myelopathy or congenital cervical narrowing.