Clinical correlation of cervical myelopathy and the hyperactive pectoralis reflex

A diagnostic study.

To validate the correlation between hyperactive pectoralis reflex and the level of cervical myelopathy.

The hyperactive pectoralis reflex was proposed to be present in patients with spinal cord compression at the C2-3 and/or C3-4 level. Nevertheless, in a validation study on the correlation of various hyperactive reflexes and the cervical myelopathic level, this particular reflex was not evaluated.

All patients presenting with cervical myelopathy between August 2009 and June 2012 were included in this study. Each patient underwent neurological examination for cervical myelopathy focusing on the examination of pathologic reflexes, including the hyperactive pectoralis reflex. We recorded the presence or absence of these reflexes and the level of cervical myelopathy as detected on magnetic resonance imaging. We used the level of spinal cord compression-cranial to C4 of the vertebral body-as the reference level to validate a hyperactive pectoralis reflex.

The study included 95 cervical myelopathy patients: 33 patients had most of their compressed cervical cord somewhere above the C4 vertebral body. The hyperactive pectoralis reflex for cervical myelopathy at this level had a respective sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 84.8%, 96.7%, 26.67, and 0.16.

The high sensitivity and specificity of the hyperactive pectoralis reflex is very useful for screening and diagnosis of the cervical myelopathic level when it is above the C4 vertebral body.