Myelopathy Tests, Diagnosis and Management of DCM

From a second 2024 scoping review, the most useful test is hyperreflexia, with a sensitivity of about 85% in the lower limbs. Andy demonstrates the Trömner sign, which performs better than Hoffmann's, the Babinski sign, ankle clonus of more than three beats and the inverted supinator sign, where tapping brachioradialis produces elbow extension or finger flexion. DCM can only be diagnosed when clinical features and MRI findings agree. Cord compression without symptoms is degenerative stenosis, and symptoms without MRI findings make myelopathy very unlikely. Under the consensus led by Fehlings and colleagues, an mJOA of 14 or less should be offered surgery, mild DCM of 15 to 17 may trial supervised rehabilitation with close follow-up, and asymptomatic compression should be safety netted without prophylactic surgery. People with compression and radiculopathy carry a higher risk and need counseling. The case is a 47-year-old man with severe C6 weakness and an mJOA of 18, whose positive Trömner sign, lower limb hyperreflexia and clonus led to an urgent MRI and decompression surgery.