Naffziger Test

The Naffziger Test is used to evaluate cervical, thoracic and lumbar spine for nerve root compression. It was named after the Howard Christian Naffziger (1884- 1961), an American neurosurgeon.

How Do You Perform the Naffziger Test?

The patient is seated, and the examiner stands behind the patient with his or her fingers over the patient’s jugular veins (which lie beside the carotid artery). The examiner compresses the veins for 30 seconds (Naffziger recommended 10 minutes!). The patient’s face flushes, and then the patient is asked to cough.

If coughing causes pain in the low back, the spinal theca is being compressed, leading to an increase in intrathecal pressure. The theca is the covering (pia mater, arachnoid mater, and dura mater) around the spinal cord.

If light-headedness or similar symptoms occur with compression of the jugular veins, the test should be terminated.

See Also: Spurling Test – Foraminal Compression Test

What Does a Positive Naffziger Test Mean?

Reproducing pain with this Naffziger Test maneuver may indicate a nerve root problem or space occupying lesion (e.g., tumor).

A study to investigate the consistency of signs and symptoms of nerve root compression in primary care patients with pain irradiating pain into the leg (sciatica), the straight leg raising, crossed straight leg raising, Bragard’s sign, and Naffziger Test were the most consistent nerve root tension signs (> 0.66).

References & More

1. Evans RC. Illustrated Essentials in Orthopedic Physical Assessment. St Louis: Mosby-Year Book; 1994
2. Edinburgh: Churchill Livingstone; 1994. 172. Gird RB, Naffziger HC. Prolonged jugular compression: a new diagnostic test of neurological value. Trans Am Neurol Assoc. 1940;66:45–49.
3. Rubinstein SM, Van Tulder M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheumatol. 2008;22(3):471–482. PubMed
4. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
5. Whonamedit? – A dictionary of medical eponyms
6. Vroomen PC, de Krom MC, Knottnerus JA. Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine (Phila Pa 1976). 2000 Jan;25(1):91-6; discussion 97. doi: 10.1097/00007632-200001010-00016. PMID: 10647166. Pubmed