The Clinical Significance Of Myelopathic Signs In Cervical Spondylotic Myelopathy Patients

Objectives: To study the clinical significance of myelopathic Signs in cervical spondylotic myelopathy patients.Materials and Methods: 88 surgically treated in-patients with definite cervical myelopathic symptoms and the presence of correlative spinal cord compression confirmed by MRI were selected as the CMS group. The control group consisted of 87 out-patients with neck/radicular complaints but no cervical myelopathic symptom and no cord compression was confirmed by MRI. The myelopathic signs included hyperreflexia (biceps, triceps, patella and Achilles) and the pyramidal signs (Hoffmann, Babinski and clonus) were executed in both groups. The prevalence and diagnosis value of physical signs were observed. The correlation of the CMS group between the presence of myelopathic signs and preoperative JOA scores, the improving rate of JOA or spinal cord signal changes were analyzed studied.Results: 1) Although the Myelopathic signs are more common in those with CMS than controls, they are not highly sensitive in diagnosing CMS. The Hoffmann sign shows the highest sensitivity of 75%; on the other hand, the clonus shows the lowest sensitivity as 21.59%. The specificity of these signs are relatively high. 2) There was a significant difference in the frequency of the myelopathic signs, the cord signal changes between those had any myelopathic signs and who without any signs. After the multivariate analysis, only the cord signal changes show the significant correlation with demonstration of myelopathic signs, with odds ratio of 6.964(95%C.I. 1.557-31.156). 3) There was no statistically significant difference of the improving rate of JOA between the subgroup 1, those who had any myelopathic signs; and subgroup 2, patients who demonstrate no signs in the CSM group. The improving rates of subgroups were both higher than 70%. Conclusions: 1) Value of myelopathic signs in diagnosis of CSM is limited, as their relatively low sensitivity.2) Age, gender, severity shows no significant correlation with presence of myelopathic signs. 3) The presence of myelopathic signs did not affect the prognosis of CSM. Patients who had significant cervical myelopathic symptoms, spinal cord compression was confirmed by MRI but without any myelopathic signs showed a considerably clinical effect after the surgical decompression have been proceeded.