Clinical tests for cervical myelopathy, compared
Compression of the spinal cord in the neck, usually from degenerative narrowing. It can cause clumsy hands, unsteady walking, symptoms in both arms or the legs, and brisk reflexes, though these signs are often absent early.
The 5 tests in the library for cervical myelopathy, side by side, each with the published accuracy figures that exist for it. Click a test for what each result means, any caution, and the source.
| Test | Sensitivity | Specificity | LR+ | LR− | Verdict |
|---|---|---|---|---|---|
| Ankle clonus | 7% | 99% | 5.49 | 0.94 | Best used to rule in |
| Babinski sign | 7% | 100% | not calculable (specificity 100%) | 0.93 | Rule-in strength not calculable (no false positives seen) |
| Gait deviation / abnormality | 19% | 94% | 3.11 | 0.86 | A weak test on its own |
| Hoffmann's sign | 31% | 73% | 1.15 | 0.95 | A weak test on its own |
| Inverted supinator sign | 18% | 99% | 14.64 | 0.83 | Best used to rule in |
Reading the table
A high LR+ makes a positive result useful for ruling the condition in; a low LR− makes a negative result useful for ruling it out. A test can be good in one direction and weak in the other, and the figures come from different studies and patient groups, so compare them with care.
No single sign rules myelopathy out; the book starts with the history, then the Cook cluster, and refers a positive cluster, or convincing symptoms with even one upper motor neuron sign.
Tests for the same problem are rarely independent, so a second positive adds much less than its own figure suggests. Do not multiply their figures together. Where a combination has been tested as a cluster or a decision rule, Rule It In, Rule It Out gives that published result.
To turn a figure into a probability for your patient, use the probability calculator.
Get the book for the neck questions that matter: nerve root or referred pain, which myelopathy signs count, and when a neck after trauma needs imaging
This page gives the published figures. Rule It In, Rule It Out adds how to do each test, what counts as positive, how to read the result, and, where studied, whether combining tests helps.
Coming in late 2026 as a PDF and a paperback. Join the list to hear when it's out
One study, one test, once a month
Rule It In is a free evidence letter for musculoskeletal clinicians: one recent study explained, one examination test with its real numbers. From Trokos, publisher of Rule It In, Rule It Out.
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