Clinical correlations of cervical myelopathy and the Hoffmann sign

The Hoffmann sign is commonly used in clinical practice to assess cervical spine disease. It is unknown whether the sign correlates with the severity of myelopathy, and no consensus exists regarding the significance of a positive sign in asymptomatic individuals.

In a retrospective review of cervical spine surgeries for myelopathy due to cervical spondylosis, ossification of the posterior longitudinal ligament, or disc herniation performed at a tertiary center, the authors compiled data on the presence of hyperreflexia, the Hoffmann and Babinski signs, and modified Japanese Orthopaedic Association (mJOA) scale scores. Then, in a prospective evaluation, new patients with lumbar spine complaints were examined for the presence of a Hoffmann sign, and, if present, a cervical MR imaging study was assessed for cord compression.

Of the 225 surgically treated patients, a Hoffmann sign occurred in 68%, hyperreflexia in 60%, and a Babinski sign in 33%. In patients with milder disability (mJOA Scores 14-16), the Hoffmann sign was present in 46%, whereas a Babinski sign occurred in 10%; in those with severe myelopathy and mJOA scores of < or =10, the Hoffmann sign was present in 81% and the Babinski sign in 83%. Of 290 patients presenting exclusively with lumbar spine-related complaints, 36 (12%) had a positive Hoffmann sign. Magnetic resonance imaging demonstrated spinal cord compression in 91% when the sign was present bilaterally and 50% when positive unilaterally.

In patients surgically treated for cervical myelopathy, the Hoffmann sign is more prevalent and more likely to be seen in individuals with less severe neurological deficits than the Babinski sign. In patients with lumbar symptoms, a bilateral Hoffmann sign was a highly sensitive marker for occult cervical cord compression, whereas a unilateral Hoffmann sign correlated with similar disease in about one-half of patients.