Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria

Genevay, Stéphane; Courvoisier, Delphine S.; Konstantinou, Kika; Kovacs, Francisco M.; Marty, Marc; Rainville, James; Norberg, Michael; Kaux, Jean-François; Thomas, D.; Katz, Jeffrey N.; Atlas, Steven J.

doi:10.1016/j.spinee.2017.10.003

Cited by 37 publications

(31 citation statements)

References 31 publications

(45 reference statements)

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“…Till date, there exists some ambiguity in the clinical diagnostic criteria for degenerative lumbar spinal stenosis. According to a study conducted in 2016, the consensus of experts on clinical symptoms included (1) pain in the lower extremities or buttocks while walking, (2) symptom relief resulting from bending the lower back forward, (3) symptom relief from bending the back forward while using a shopping cart or riding a bicycle, (4) motor or sensory disturbance while walking, (5) normal and symmetrical pulse of the dorsalis pedis artery, (6) weakening of lower extremity, and (7) lower back pain [ 13 , 14 ]. In other studies, detailed history, gait, and some physical examination findings were also included in the classification criteria [ 13 , 15 , 19 ].…”

Section: Clinical Evaluationmentioning

confidence: 99%

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

et al. 2020

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Patients with lumbar spinal stenosis may exhibit symptoms such as back pain, radiating pain, and neurogenic claudication. Although long-term outcome of treatments manifests similar results for both nonsurgical and surgical treatments, positive effects such as short-term improvement in symptoms and decreased fall risk may be expected with surgery. Surgical treatment is basically decompression, and a combination of treatments can be added depending on the degree of decompression and the accompanying instability. Recently, minimally invasive surgery has been found to result in excellent outcomes in the treatment of lumbar spinal stenosis. Therefore, better treatment effects can be anticipated with an approach aimed at understanding the overall pathophysiology and treatment methods of lumbar spinal stenosis.

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Section: Clinical Evaluationmentioning

confidence: 99%

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

et al. 2020

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“…Alternatively, we could have chosen to include a Delphi process based on expert opinion to select the most relevant questions. However, three 2,15,16 of the five identified papers were already based on large expert surveys from 2013, 2016 and 2018, respectively, and it is therefore unlikely that redoing the process would have brought about new questions. On the contrary, this study may inform future research focusing on identifying new dimensions to identify LSS patients rather than confirming questions already included.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were categorised as LSS-patients by the clinician if they had clinical symptoms of LSS (neurogenic claudication) based on diagnostic criteria in line with the recent suggestions of clinical diagnosis of LSS. 2,15,16 The diagnosis of neurogenic claudication is a clinical assessment primarily based on key items of the case history and ruling out the differential diagnosis by a clinical examination.…”

Section: Patient Categorisationmentioning

confidence: 99%

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<p>Diagnostic Screening for Lumbar Spinal Stenosis</p>

Jensen

Lauridsen

Andresen

et al. 2020

CLEP

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Purpose: To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items. Patients and Methods: A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire. Results: A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%. Conclusion: The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes.

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“…Most patients in the ATLAS study received physiotherapy treatment, with a small number of patients being referred for a specialist opinion for consideration of further management options such as spinal injections or surgery, if their symptoms did not respond to conservative management and taking into account their MRI findings [14]. For the development of the algorithm we included ATLAS participants diagnosed with sciatica with diagnostic confidence of 70% and over (as reported by the assessors) [16, 17]. The outcome definition was referral to NHS spinal specialist services (yes/no).…”

Section: Methodsmentioning

confidence: 99%

Subgrouping patients with sciatica in primary care for matched care pathways: development of a subgrouping algorithm

Konstantinou

Dunn

Windt

et al. 2019

BMC Musculoskelet Disord

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Background Sciatica is a painful condition managed by a stepped care approach for most patients. Currently, there are no decision-making tools to guide matching care pathways for patients with sciatica without evidence of serious pathology, early in their presentation. This study sought to develop an algorithm to subgroup primary care patients with sciatica, for initial decision-making for matched care pathways, including fast-track referral to investigations and specialist spinal opinion. Methods This was an analysis of existing data from a UK NHS cohort study of patients consulting in primary care with sciatica ( n = 429). Factors potentially associated with referral to specialist services, were identified from the literature and clinical opinion. Percentage of patients fast-tracked to specialists, sensitivity, specificity, positive and negative predictive values for identifying this subgroup, were calculated. Results The algorithm allocates patients to 1 of 3 groups, combining information about four clinical characteristics, and risk of poor prognosis (low, medium or high risk) in terms of pain-related persistent disability. Patients at low risk of poor prognosis, irrespective of clinical characteristics, are allocated to group 1. Patients at medium risk of poor prognosis who have all four clinical characteristics, and patients at high risk of poor prognosis with any three of the clinical characteristics, are allocated to group 3. The remainder are allocated to group 2. Sensitivity, specificity and positive predictive value of the algorithm for patient allocation to fast-track group 3, were 51, 73 and 22% respectively. Conclusion We developed an algorithm to support clinical decisions regarding early referral for primary care patients with sciatica. Limitations of this study include the low positive predictive value and use of data from one cohort only. On-going research is investigating whether the use of this algorithm and the linked care pathways, leads to faster resolution of sciatica symptoms. Electronic supplementary material The online version of this article (10.1186/s12891-019-2686-x) contains supplementary material, which is available to authorized users.

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Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria

Abstract: Clinical criteria independently associated with neurogenic claudication due to LSS were identified. The use of these symptom and physical variables as a classification score for clinical research could improve homogeneity among enrolled patients.

Cited by 37 publications

References 31 publications

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

<p>Diagnostic Screening for Lumbar Spinal Stenosis</p>

Subgrouping patients with sciatica in primary care for matched care pathways: development of a subgrouping algorithm

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