Reliability of diagnosis of soft cervical disc prolapse using Spurling's test

Abstract

The purpose of this study was to determine the sensitivity and specificity of the Spurling's test in predicting the diagnosis of a soft lateral cervical disc prolapse. A prospective study was performed involving 50 patients with neck and arm pain; of these, 25 patients were managed surgically (Group 1) and the other 25 patients were managed conservatively (Group 2). A Spurling's test was performed in all patients and scored as positive or negative. In patients in Group 1, the operative findings were recorded as a soft or hard disc prolapse (osteophyte). In Group 2 patients, the MR findings were recorded as positive for a soft disc prolapse or negative (no disc prolapse or osteophyte only). The results of the Spurling's test were compared with the surgical or MR findings, which were considered as the gold standard. Spurling's test had a sensitivity of 92% and specificity of 95% with positive predictive value (PPV) of 96.4% and negative predictive value (NPV) of 90.9% in predicting a diagnosis of a soft lateral cervical disc prolapse. The high positive predictive value of the test can be utilized to improve the yield of positive MR examinations in patients with cervical radiculopathy.