An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study

• Frequency of finger flexion, Hoffman's and plantar reflexes assessed.
• Two groups – controls and patients with neck complaints.
• Frequency in controls: FF – 1%, Hoffman's – 0.3%, Babinski – 0%.
• None of the controls with positive reflexes had any abnormality on MR imaging.
• Combining the three reflexes was the best for detecting spinal cord compression.

ObjectivesThis study aimed at determining the frequency of abnormal finger flexion, Hoffman's and extensor plantar (Babinski) response in healthy adults and to determine the sensitivity and specificity of these tests as markers of spinal cord compression in symptomatic patients.MethodsPatients attending the neurosurgery clinic with neck related complaints formed the case group. The control group consisted of consenting patient attenders and volunteers drawn from the students and faculty of our institute. All subjects underwent examination of the finger flexion, Hoffman's and plantar reflexes and an MRI as per standard protocol. The frequency of the reflexes in the control group, sensitivity and specificity of the reflexes to detect cord compression in the case group were computed.ResultsThe frequency of the reflexes in healthy controls were finger flexion – 1%, Hoffman's – 0.3% and Babinski sign – 0%. None of the controls with positive reflexes had any abnormality on MR imaging. A combination of the three reflexes had a sensitivity of 91.7%, specificity of 87.5%, PPV of 95.7% and NPV of 77.8% in detecting spinal cord compression.ConclusionsA combination of finger flexion, Hoffman's and plantar reflexes could be used effectively as a marker of spinal cord compression in symptomatic individuals. They cannot, however, be depended on as screening tests in asymptomatic individuals.