Which of the following is NOT a CPR point for cervical myelopathy?

• A. Gait deviation
• B. + Hoffmans
• C. Inverted supinator sign
• D. Numbness in toes

Answer: (D)

Clinical prediction rules for cervical myelopathy rely on objective signs of cord involvement that reflect upper motor neuron pathways affected by cervical compression. Gait deviation shows how the cord issue disrupts lower limb function and ambulation, making it a relevant predictor. A positive Hoffmann sign is a classic upper motor neuron indicator from cervical cord involvement. The inverted supinator sign is another upper motor neuron–driven reflex pattern seen with cervical myelopathy. Numbness in the toes, while a sensory complaint, is not specific to cervical spinal cord pathology and can arise from many other conditions, so it isn’t used as a CPR point for cervical myelopathy.