The Significance of the Trömner Sign in Cervical Spondylotic Myelopathy Patient

Clin Spine Surg. 2017 Nov;30(9):E1315-E1320. doi: 10.1097/BSD.0000000000000412.


Study design: This study is a diagnostic analysis.

Objective: To investigate the diagnostic accuracy of Trömner sign in cervical spondylotic myelopathy (CSM), and how its presence correlates with the severity of myelopathy.

Summary of background data: A clinical presentation of myelopathy corresponding with image findings is a current standard to diagnose CSM. Trömner sign is an alternative of well-known Hoffmann sign to detect CSM. Little is known about its diagnostic accuracy and how its presence correlates with the severity of CSM.

Materials and methods: Consecutive patients with clinical diagnosis of CSM and other cervical spondylosis-related problems were enrolled in either CSM group, cervical spondylotic radiculopathy group, or axial pain group. Normal volunteers and patients without spine-related issues were used as a control. All participants were examined for the presence of myelopathic signs. Magnetic resonance imaging studies of all participants were reviewed by a radiologist.

Results: There were 85 participants included in the study. Diagnostic sensitivity was 76%, 94%, 76%, and 36% for Hoffmann sign, Trömner sign, inverted radial reflex, and Babinski sign, respectively. Trömner sign had relatively high sensitivity (95%) despite of mild degree of myelopathy. Negative predictive value was 60%, 85%, 59%, and 38% for Hoffmann sign, Trömner sign, inverted radial reflex, and Babinski sign, respectively. There were 63%-71% of patients in either axial pain group or cervical spondylotic radiculopathy group had positive Trömner sign. Most of CSM patients with cord signal changed had positive myelopathic sign. Regarding CSM patient without cord signal change, most of tests were negative except Trömner sign.

Conclusions: High sensitivity (94%) and relatively high negative predictive value (85%) for Trömner sign indicate the usefulness of Trömner sign in ruling out CSM. High incidence of positive Trömner sign in presymptomatic cervical cord compression patients suggests Trömner sign could have a useful role in early detection of presymptomatic patients.

MeSH terms

  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / physiopathology*
  • Cervical Vertebrae / surgery*
  • Demography
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Reflex*
  • Spinal Cord Compression / complications
  • Spinal Cord Compression / diagnostic imaging
  • Spondylosis / diagnostic imaging
  • Spondylosis / physiopathology*
  • Spondylosis / surgery*