BACKGROUND: Degenerative cervical myelopathy (DCM) is the most common cause of age-related spinal cord dysfunction worldwide. Despite the widespread use of provocative physical exam maneuvers in the workup of DCM, the clinical significance of Hoffmann's sign is controversial. OBJECTIVE: The purpose of this study was to prospectively assess the diagnostic performance of Hoffmann's sign for DCM in a cohort of patients treated by a single spine surgeon. MATERIALS & METHODS: Patients were divided into two groups based on the presence of a Hoffmann sign on physical examination. Advanced imaging studies were independently reviewed by four raters for confirmation of a diagnosis of cervical cord compression. Prevalence, sensitivity, specificity, likelihood, and relative risk ratios for the Hoffmann sign were calculated, with subsequent Chi-square and receiver operator characteristic (ROC) analysis to further characterize correlative findings. RESULTS: Fifty-two patients were included - of whom, thirty-four (58.6%) patients presented with a Hoffmann sign, and eleven (21.1%) patients demonstrated cord compression on imaging. The Hoffmann sign demonstrated a sensitivity of 20% and a specificity of 35.7% (LR = 0.32; 0.16-1.16). Chi-square analysis revealed that imaging findings positive for cord compression were proportionally greater for patients lacking a Hoffmann sign than those with a confirmed Hoffmann sign ( =0.032) ROC analysis demonstrated that a negative Hoffmann sign performed moderately well in predicting cord compression (AUC.721; =0.031). CONCLUSIONS: The Hoffmann sign is an unreliable marker for cervical cord compression, and the lack of a Hoffmann sign may be more predictive of cervical cord compression.