Hoffmann’s Sign as a Diagnostic Marker for Cervical Myelopathy: Systematic Review and Meta-analysis
C. Shivaleela, B. Srinivasa Sagar, C. S. Ramya, S. Viveka, S. Rahul, M. P. Sudarshan, O. S. Suprith, Arun Kumar NamachivayamIntroduction:
Despite widespread use, Hoffmann’s sign as a standalone diagnostic clinical sign of cervical myelopathy remains uncertain due to inconsistent reporting of sensitivity and specificity across studies. The objective of this review was to systematically evaluate and quantitatively synthesize the diagnostic utility of Hoffmann’s sign in detecting cervical myelopathy.
Methods:
A systematic review and meta-analysis of diagnostic accuracy studies published between 2000 and 2025 were conducted. Databases searched included PubMed/MEDLINE, Embase, Scopus, and Google Scholar. Studies assessing Hoffmann’s sign against magnetic resonance imaging or established clinical diagnosis were included. Data were extracted to construct 2 × 2 contingency tables, and odds ratios were extracted or calculated. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies-2. Sensitivity of the test was pooled using a bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were generated, and heterogeneity was evaluated using the
Results:
Nine eligible studies encompassing heterogeneous clinical populations were included. Pooled sensitivity of Hoffmann’s sign using a bivariate random effects model was 0.58 (95% confidence interval: 0.38–0.75). The pooled specificity was 0.69, corresponding to a false positive rate of 0.31. The SROC yielded an area under the curve of 0.675, indicating only modest discriminatory ability. Substantial heterogeneity was noted (
Conclusion:
Therefore, it is concluded that Hoffmann’s sign should not be used as a standalone diagnostic test for cervical myelopathy. Its clinical utility is optimized when interpreted alongside complementary neurological findings and imaging.