Doctor of Physical Therapy (Dpt) Program, Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Texas Tech University Health Sciences Center School of Medicine, Lubbock Campus: Texas Tech University Health Sciences Center School of Medicine,Lubbock, TX, USA.
J Man Manip Ther. 2022 Dec;30(6):357-364. doi: 10.1080/10669817.2022.2056363. Epub 2022 Mar 21.
Neurologic clustering of findings is recommended with Cervical Spondylotic Myelopathy (CSM). Hoffmann's Sign and Reverse Lhermitte's Sign have been associated with CSM, which, however, have not been discussed as the only objective findings that may cause clinical uncertainty.
This case report describes how sensitizing Hoffmann's Sign following a Reverse Lhermitte's Sign guided reasoning, with a 66-year-old male presenting with a right lumbar radiculopathy diagnosis. Local lumbar symptoms and impairments were identified, however, a Reverse Lhermitte's Sign with cervical extension was the only finding that reproduced right lower extremity (LE) pain. Hoffmann's Sign, the only abnormal neurologic finding, became exaggerated when performed in cervical extension. Concern of an early presenting CSM accounting for right LE pain was considered. A neurosurgical consultation was initiated with concurrent guideline-based lumbar spine treatment and continued monitoring of neurologic status.
Seven weeks after evaluation, sudden worsening of right LE symptoms, hand numbness, ataxia, and grip weakness occurred. Cervical magnetic resonance imaging demonstrated C3-6 cord compression. A multi-level cervical decompression surgery was performed.
Using a sensitized Hoffmann's Sign-in response to a Reverse Lhermitte's Sign aided differential diagnosis of an early presenting CSM with reports of LE pain. The diagnostic utility of a sensitized Hoffmann's Sign is unknown.
颈椎脊髓病（CSM）推荐对神经学表现进行聚类。Hoffmann 征和反向 Lhermitte 征与 CSM 相关，但尚未被讨论为唯一可能导致临床不确定性的客观发现。
本病例报告描述了如何在出现反向 Lhermitte 征后，通过敏感化 Hoffmann 征来引导推理，一名 66 岁男性被诊断为右腰神经根病变。局部腰椎症状和功能障碍被识别，但只有在颈椎伸展时出现的反向 Lhermitte 征才能重现右下肢（LE）疼痛。Hoffmann 征是唯一的异常神经学发现，当在颈椎伸展时进行时，其变得更加明显。考虑到可能存在早期表现的 CSM 导致右下肢疼痛。启动了神经外科会诊，同时进行基于指南的腰椎治疗，并继续监测神经状态。
评估后 7 周，突然出现右下肢症状恶化、手部麻木、共济失调和握力减弱。颈椎磁共振成像显示 C3-6 脊髓受压。进行了多节段颈椎减压手术。
使用敏感化的 Hoffmann 征来应对反向 Lhermitte 征有助于对早期表现的 CSM 进行鉴别诊断，该 CSM 伴有下肢疼痛的报告。敏感化 Hoffmann 征的诊断效用尚不清楚。
