Table 1

Cases of degenerative cervical myelopathy identified by a chiropractor

*Advanced imaging for the cervical spine including computed tomography or magnetic resonance imaging

ACDF - anterior cervical discectomy and fusion,
CTS - carpal tunnel syndrome,
CT - computed tomography,
MVC - motor vehicle collision,
MRI - magnetic resonance imaging,
PMR - physical medicine and rehabilitation,
ROM - range of motion

Author(s), year	Patient age	Patient sex	Symptoms	Examination findings	Previous advanced imaging*	Management
Bolles et al., 2022 [30]	49	M	Chronic, atraumatic neck and arm pain, worsening gait/balance, hand dysesthesia, prior CTS surgery	Abnormal tandem walk, fasciculations, lower extremity hyperreflexia, apallesthesia, upper extremity weakness	No	Cervical MRI, referred to neurosurgeon, anterior decompression and disc replacement at C4/5, C5/6
Bolles et al., 2022 [30]	38	F	Neck pain after recent MVC; extremity paresthesia, unsteadiness	Abnormal tandem walk, hyperreflexia, Hoffman sign, clonus, upper and lower extremity weakness	No	Cervical MRI, referred to neurosurgeon, underwent ACDF
Cates and Soriano, 1995 [32]	55	M	Neck, shoulder and right arm pain and hand weakness	Hyperreflexia, upgoing Babinski, asymmetrical lower extremity sensory deficit	Yes	Referred to neurosurgeon, posterior decompressive laminectomy
Crawford et al., 1995 [33]	38	M	Neck stiffness, left shoulder and arm pain, finger numbness.	Sensory deficits, hyperreflexia, Hoffman sign, clonus, Lhermitte phenomenon	No	Radiographs, myelography, CT, referred to neurosurgeon, posterior decompressive laminectomy C5/6
Crawford et al., 1995 [33]	73	M	Low-back and right lower extremity pain	Ataxia, hyperreflexia, Hoffman sign	No	Radiographs, CT, referral to surgeon (not surgical candidate)
Current case, 2022	62	F	Neck, shoulder pain; hand numbness, weakness	Hyperreflexia, Hoffman sign, hand sensory deficit, upper limb weakness	Yes	Referral to neurosurgeon, ACDF C4-7
Boesch and Nekoomand, 2011 [34]	47	M	Low back pain and bilateral lower extremity weakness, nausea, dizziness, blurred vision	Unclear	No	Radiographs, MRI, surgical consultation; surgical decompression
King et al., 2011 [14]	53	F	Immobility of lower extremities, paresthesia of fingers, head, back	Hyperreflexia, Hoffman reflex, reduced C/S ROM	No	Cervical MRI, referred to neurosurgeon, underwent C3-7 posterior fusion
Murphy and Beres, 2008 [35]	38	M	Left arm pain, numbness, lower extremity paresthesias, weakness	Ataxia on tandem walking, increased sway with Romberg test, hyperreflexia, absent umbilical reflexes	Yes	Referred to neurosurgeon, ACDF
Price et al., 2021 [13]	58	M	Thoracic pain, dropping things	Hoffman reflex, hyperreflexia, ankle clonus, lower extremity weakness	No	Referred to PMR, MRI, C5/6, C6/7 ACDF
Toto, 1986 [36]	84	M	Hip pain, low back pain, constipation	Mixed hyper- and hyporeflexia; multiple pathological reflexes, including Hoffman sign; clonus, rigidity, sensory deficits	No	Cervical radiographs, CT, referred to neurologist, deemed not a surgical candidate
Troutner and Barbato, 2022 [31]	57	M	Neck pain, upper extremity paresthesia and weakness, CTS diagnosis	Abnormal tandem gait, hyperreflexia, clonus, Hoffman sign, hypoesthesia,	No	Cervical MRI, referred to neurosurgeon; C4-5 anterior cervical discectomy and fusion