Correlation between a positive Hoffmann's reflex and cervical pathology in asymptomatic individuals

Study Design. Asymptomatic patients with a positive Hoffmann's reflex were prospectively studied with cervical radiographs and magnetic resonance imaging. Objectives. To determine a relationship between a positive Hoffmann's reflex and cervical pathology in asymptomatic patients and to evaluate if further work-up was necessary in this patient population. Summary of Background Data. A positive Hoffmann's reflex usually implies an upper motor neuron lesion from spinal cord compression. Although this reflex is commonly tested, the significance of this reflex in asymptomatic patients is not known. Methods. Sixteen patients without cervical pain or radiculopathy and a positive Hoffmann's reflex were prospectively studied with cervical radiographs and magnetic resonance imaging. Positive findings were correlated with a detailed neurologic examination. Results. All 16 patients were asymptomatic. Fourteen patients (87.5%) demonstrated spondylosis on cervical radiographs. The magnetic resonance imaging studies showed pathologic findings in all 16 patients. Fifteen patients (94%) had cervical involvement with cord compression from a herniated nucleus pulposus. The remaining patient had a T5-T6 thoracic disc with resultant compression. No treatment was instituted, and the clinical course of each patient was not affected. Conclusions. Although the presence of cervical cord impingement is extremely high in these patients, no treatment was rendered specifically to address the cervical pathology. Therefore, the presence of a positive Hoffmann's reflex in asymptomatic patients strong ly suggests underlying cervical pathology, but it does not warrant further evaluation with either cervical radiographs or magnetic resonance imaging since the management and clinical course are not affected by positive studies.