Cervical Myelopathy

Question 1

A patient comes in with poor balance and walks with a wide base of support.
how could you further assess for UMN involvement?

Answer 1

Rule in:
wide base of support - spec - 94%
clonus - spec 99%
postive inverted supinator sign - spec 93%

Rule out:
hyper-reflexia - sensitivity - 72% (although CI: 55%- 85%)
Tromner’s sign - sensitivity - 94%

Question 2

What are 4 clinical tests that could rule in a cervical myelopathy

Answer 2

Positive inverted supinator sign - Specificity 93%, Sensitivity 41%
Babinski’s - Specificity 99%, sensitivity 17%
Tromners sign - specifivity 94%, sensivity - 93%
wide base of support - specificity 94%, sensitivity 19%
Clonus - specificity 99%, sensitivity 9%

Question 3

what investigations would you order to further assess suspected Myelopathy

Answer 3

MRI - more accurate than CT

Question 4

What’s the best test to rule out cervical myelopathy?

Answer 4

1. Tromners sign - sensitivity 94%
2. Hyperreflexia (absence of) - sensitivity 72% - although has large CI’s

Question 5

What is the sensitivity and specificity of the Sharp Purser test?

Answer 5

sensitivity = 19-69%
specificity 70-98%

The Sharp Purser test has moderate sensitivity and high specificity, making it useful for ruling in conditions.

Question 6

Which test for cervical instability is noted to be the least sensitive and specific?

Answer 6

Sharp Purser test

Despite being the least sensitive and specific, the Sharp Purser test is still recommended to be performed first.

Question 7

What characteristic of the Sharp Purser test makes it less provocative?

Answer 7

It is a relocation test

The nature of the Sharp Purser test as a relocation test contributes to its lower provocative nature.

Question 8

What is the sensitivity and specificity of the Alar Ligament test (Rotation)?

Answer 8

Sensitivity = 69-72%
Specificity 96-100%

The Alar Ligament test has a moderate sensitivity range.

Question 9

What does the Alar Ligament test (Rotation) assess?

Answer 9

The alar ligament on the contralateral side to the direction of rotation

This test evaluates the integrity of the alar ligament in relation to head rotation.

Question 10

What is the general sensitivity and specificity trend of the tests discussed?

Answer 10

Moderate sensitivity, high specificity

This trend indicates the tests are more effective at ruling conditions in than out.