[Objective] To investigate the possible etiology and pathogenesis of Lhermitte&rsquo sign in cervical spondylosis. [Methods] The diagnosis, treatment selection, and follow-up data of three patients with positive Lhermitte sign among 800 cervical spondylosis patients counted from October 2000 to October 2006 were analyzed in conjunction with the existing literature. [Results] One patient underwent anterior cervical decompression graft fusion internal fixation surgery, and the Lhermitte’s sign disappeared completely after surgery; the second case had a significant reduction in the number of Lhermitte’s sign episodes after conservative treatment, and the third case had ineffective conservative treatment but did not agree to surgical treatment. [Conclusion] All three patients had long-term instability of the lower cervical spine, resulting in hyperplasia of the anterior and posterior edges of the vertebral body, hypertrophy of the endplate sclerotic ligamentum flavum, and anterior and posterior compression of the dural sac. Repeated instability and vertebral hyperplasia and hypertrophy of the ligamentum flavum may be the cause of demyelination changes in the cervical segment of the spinal cord, causing Lhermitte&rsquo signs. Decompression and stabilization is an effective treatment for cervical spondylosis combined with Lhermitte’s sign.