A Systematic Review of the Utility of the Hoffmann Sign for the Diagnosis of Degenerative Cervical Myelopathy

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Study Design.

Systematic review


To determine the validity of the Hoffmann sign for the detection of degenerative cervical myelopathy (DCM) for patients presenting with cervical complaints.

Summary of Background Data.

While physical exam maneuvers are often used to diagnose DCM, no previous review has synthesized diagnostic accuracy data.


Medline, Embase and HealthStar were searched for articles from 1 January 1947 to 1 March 2017 using the following terms: Spinal Cord Diseases, Spinal Cord Compression, Cervical Vertebrae, Signs and Symptoms, Physical Examination, Epidemiologic studies, Epidemiologic Research Design, Predictive Value of Tests and Myelopathy. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist was applied to determine the level of evidence. Articles included were published in English or French language, rated as QUADAS level 3 or higher with a minimum 10 patients presenting with cervical complaints having undergone the Hoffman sign. Excluded studies recruited patients with a non-degenerative type of cervical myelopathy, and/or no evaluation with MRI.


A total of 589 articles were selected for review. Following the application of inclusion and exclusion criteria, 45 articles were analyzed using the QUADAS checklist. Only of 3 articles were of QUADAS quality 3 or higher. Analysis of combined data from 2/3 studies indicated that the Hoffman sign has a positive likelihood ratio (LR) of 2.2 (95% CI 1.5–3.3) and a negative LR of 0.63 (95% CI 0.5–0.8).


A positive Hoffman alone is unlikely to lead to more than a small change in estimated probability of DCM as compared to the gold standard test (MRI). Variability in results across individual studies may result from differences in study design. There are insufficient data to support use of the Hoffman sign alone to confirm or refute a diagnosis of DCM.


Level of Evidence: 1

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