The major focus of the exam is directed at nd­ing a neurologic decit (Table10.1). A dermatomal or myotomal decit, such as decreased strength, sensory decit (often decreased sensation to light touch), or diminished deep tendon reex is most likely an objective nding in a patient with a radiculopathy. Although less reproducible, man­ual tests and maneuvers that increase or decrease radicular symptoms may be helpful. In the Spurling’s test, the patient’s head is extended, tilted laterally, and slightly rotated toward the symptomatic side, and then compressed to elicit reproduction or aggravation of the radicular symptoms. The axial manual traction test is per­formed in the presence of radicular symptoms in the supine position. With 20–25lb of axial trac­tion, a positive test is the decrease or disappear­ance of radicular symptoms. All these tests are highly specic (low false-positive rate) for the diagnosis of root compression, but the sensitivity (false-negative rate) is less than 50%. L’hermitte’s sign is a feeling of electric shock extending dis­tally down the axial spine with exion at the neck, which can indicate spinal cord compression. It is worth noting that a C5 nerve root palsy is the most common palsy in the cervical spine. This can be seen preoperatively but is more commonly seen post- operatively after cervical decompression. Patients present with acute weakness of the del­toid and biceps as well as radicular pain in the C5 distribution. Patients should be counseled that in most cases this will likely resolve spontaneously within 6 months. The exact etiology of the C5 palsy is not known, but one proposed theory is that decompression and posterior translation of the spinal cord results in traction on the C5 nerve root, resulting in a palsy.