What is the purpose and procedure of the Spurling test in diagnosing cervical radiculopathy?

The Spurling Test for Cervical Radiculopathy

The Spurling test is a highly specific (94%) but moderately sensitive (30-95%) provocative maneuver used to diagnose cervical radiculopathy by reproducing radicular symptoms through compression of cervical nerve roots as they exit the neural foramina. 1, 2

Purpose of the Spurling Test

The Spurling test serves as a clinical examination tool to:

• Identify patients with probable cervical nerve root compression
• Help determine which patients should undergo advanced imaging studies (MRI or CT)
• Confirm a clinical diagnosis of cervical radiculopathy when positive
• Reproduce the characteristic radicular symptoms in affected patients

Procedure for Performing the Spurling Test

The most effective way to perform the Spurling test involves a sequential approach:

1. Basic Position: Have the patient seated comfortably

2. Most Effective Technique:

   • Begin with neck extension and lateral bending toward the symptomatic side
   • Then add axial compression (downward pressure on the head)
   • This combination produces the highest pain scores (mean VAS 7) and most distal pain radiation 3

3. Alternative Technique:

   • Extension, rotation toward the symptomatic side, and axial compression
   • This produces the highest paresthesia levels but may be less tolerable for patients 3

Interpretation of Results

• Positive Test: Reproduction of the patient's radicular symptoms (pain or tingling) that:

  • Start in the shoulder
  • Radiate distally to the elbow or beyond
  • Match the patient's typical pain pattern

• Diagnostic Value:

  • High specificity (93-94%) - a positive test strongly suggests cervical radiculopathy
  • Variable sensitivity (30-95%) - a negative test does not rule out radiculopathy 1, 2

Clinical Implications

• Patients with a positive Spurling test should be referred for imaging studies (MRI preferred) to confirm nerve root compression 1
• The test should be used in conjunction with other clinical findings, as MRI alone should not be used to diagnose symptomatic cervical radiculopathy due to frequent false-positive and false-negative findings 4
• A negative Spurling test does not exclude cervical radiculopathy due to its limited sensitivity 2

Cautions and Considerations

• Perform the test carefully in patients with known cervical radiculopathy to avoid exacerbation
• The test may be poorly tolerated in patients with severe symptoms
• Patients with cervical radiculopathy should be advised to avoid positions that mimic the Spurling test in daily activities (e.g., salon sink hair washing, which can cause hyperextension with rotation and side-bending) 5
• The test should be part of a comprehensive evaluation that includes other provocative tests, such as the shoulder abduction test 6

Integration with Diagnostic Pathway

1. Perform the Spurling test as part of the initial physical examination
2. If positive, consider MRI as the gold standard for assessing soft tissue and neural element damage 7
3. CT scan may be preferred for evaluating osseous structures, particularly in cases of suspected OPLL 4, 7
4. Interpret imaging findings in conjunction with clinical symptoms, as 75-90% of cervical radiculopathy cases improve with conservative therapy 4

The Spurling test remains a valuable clinical tool that, when positive, provides strong evidence for cervical radiculopathy and helps guide appropriate imaging and treatment decisions.