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What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy.

Questions/Purposes

We assessed the ability of six known variations of the Spurling test to reproduce the complaints of patients diagnosed with cervical radiculopathy.

Methods

We prospectively enrolled 67 patients presenting with cervical radicular-like symptoms and concordant radiographic findings. Each patient underwent six distinct provocative cervical spine maneuvers by two examiners, during which three parameters were recorded: (1) pain intensity (VAS score), (2) paresthesia intensity (0 - no paresthesia, 1 - mild to moderate, and 2 - severe), and (3) characteristic pain distribution (0 - no pain, 1 - neck pain only, 2 - arm pain only, 3 - pain elicited distal to the elbow). The interobserver reliability of the reported VAS score (measured by the intraclass coefficient correlation) ranged from 0.78 to 0.96 and the calculated kappa values of the categorical parameters ranged from 0.58 to 1.0 for paresthesia intensity and from 0.63 to 1.0 for pain distribution. Differences in scores elicited between the two examiners for the 67 patients were resolved by consensus.

Results

A maneuver consisting of extension, lateral bending, and axial compression resulted in the highest VAS score (mean, 7) and was associated with the most distally elicited pain on average (mean, 2.5). The highest paresthesia levels were reported after applying extension, rotation, and axial compression (mean, 1). These maneuvers, however, were the least tolerable, causing discontinuation of the examination on three occasions.

Conclusions

Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Spine Unit, Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin, Israel

    Yoram Anekstein MD, Ronen Blecher MD, Yossi Smorgick MD & Yigal Mirovsky MD

Authors
  1. Yoram Anekstein MD
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  2. Ronen Blecher MD
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  3. Yossi Smorgick MD
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  4. Yigal Mirovsky MD
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Corresponding author

Correspondence to Yoram Anekstein MD.

Additional information

Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent-licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained from all subjects.

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Anekstein, Y., Blecher, R., Smorgick, Y. et al. What is the Best Way to Apply the Spurling Test for Cervical Radiculopathy?. Clin Orthop Relat Res 470, 2566–2572 (2012). https://doi.org/10.1007/s11999-012-2492-3

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  • DOI: https://doi.org/10.1007/s11999-012-2492-3

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