compression may occur from (1) osteophytes secondary to degeneration of intervertebral joints, (2) stiffening of connective tissues, such as the ligamentum flavum at the dorsal aspect of the spinal canal, which can impinge on the cord by C ervical spine myelopathy resulting from sagittal narrowing of the spinal canal and compression of the spinal cord is present in 90% of individuals by the seventh decade of life.32 Although the exact prevalence is unknown, 32 cervical spine myelopathy is recognized as the most common form of spinal cord dysfunction in individuals over the age of 55.39 Cord"buckling" when the spine is extended, (3) degeneration of intervertebral discs together with subsequent bony changes, and (4) other connective tissue changes. 47Diagnosis of myelopathy is challenging, particularly in the early stages of the condition, as symptoms may present as hyperreflexia, 27,32,33,38 clumsiness in gait, 3,27,32,33,38 neck stiffness, 10,32,33,38 shoulder pain, 11 paresthesia in 1 or both arms or hands, 22 or radiculopathic signs. 24,32,33,38 When suspected after pertinent clinical examination findings, a diagnosis of myelopathy is confirmed or refuted by magnetic resonance imaging (MRI). Myelopathy may lead to anterior-posterior width reduction of the spinal cord, cross-sectional evidence of cord compression, or obliteration of the subarachnoid space. 6,19,34,35,46 At present, there are no definitive objective findings on MRI consistently described by radiologists that are reflective of myelopathy, with the exception of myelomalacia (identified through signal intensity changes to the cord). Signal intensity changes have been described as the most appropriate "gold standard" for confirmation of a spinal cord compression myelopathy. 1,9,21,25,[28][29][30]37 The clinical examination for myelopathy includes the use of Hoffmann's Case control study.Myelopathy is a clinical diagnosis based largely on initial examination findings during a clinical screen, followed by imaging verification of cord injury or compression. At present, few studies have examined the reliability and diagnostic accuracy of clinical examination measures.To determine the reliability and diagnostic accuracy of neurological tests associated with the diagnosis of myelopathy.Reliability and diagnostic accuracy of 7 frequently used tests and measures and subjective findings associated with myelopathy were examined on consecutive patients with cervical pain. Interrater reliability and diagnostic accuracy values, including posttest probability, based on a pretest probability of 40%, were calculated for each test and for combinations of tests and measures.Four of the 7 diagnostic tests were found to have a substantial interrater reliability.None of the single or clusters of tests yielded low negative likelihood ratios. Of the individual tests, the Babinski sign demonstrated the highest positive likelihood ratio (LR+, 4.0; 95% CI: 1.1-16.6) and posttest probability (73%) for diagnosis, but yielded only a moderate negative likelihood rati...

We report two cases of Caesarean section in patients with Marfan's syndrome where continuous subarachnoid anaesthesia failed to provide an adequate surgical block. This was possibly because of dural ectasia, which was confirmed by a computed tomography scan in both cases.

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