Low Back Pain on Passive Straight Leg Raising

Summers, Bruce; Malhan, Kaushal; Cassar‐Pullicino, Victor N.

doi:10.1097/01.brs.0000152378.93868.c8

Cited by 18 publications

(7 citation statements)

References 10 publications

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“…This will reflect not only on the intervertebral disks and nerve roots, but also on all intra-and extra-dural structures, aggravating the radicular compression by the herniated disk, not only in the intervertebral foramen, but also in central hernias, central posterior-lateral, posterior-lateral, and paramedian posterior-lateral herniated disks, aggravating preexisting symptoms or making them appear by working as facilitators of the approximation between the nerve tissue and the dislodged disk material. 5,23 The sensitivity of Cecin's sign can also be higher in patients with lower anatomofunctional reserve during flexion of the lumbar spine, in which the sagittal diameter and area of the vertebral canal decreases. 24,25…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, many authors admit that the maneuver can only be considered as indicative of effective root compression at a 45° angle. 3,4,5 False-positive results represent other confounding factor of Lasègue's sign: referred pain in the path of the sciatic nerve would result from increased tension of the thigh muscles and not radicular compression. Although it is still very important in the diagnosis of herniated lumbar disks, due to the current tendency to use the 45° angle as criterion for radicular compression, the sensitivity and specificity of Lasègue's sign should be cautiously interpreted.…”

mentioning

confidence: 99%

“…In this review, the authors admitted that differences between a positive and a negative sign are very subtle. 3,4,5,6 Thus, the search for other semiotic maneuver could minimize those divergences, increase reliability, and validate the superiority of the clinical exam in the diagnosis of symptomatic herniated lumbar disks.…”

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confidence: 99%

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Sinal de Cecin (Sinal "X"): um aprimoramento no diagnóstico de compressão radicular por hérnias discais lombares

Cecin¹

2010

Rev. Bras. Reumatol.

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Due to the high prevalence, negative repercussions on working capacity, and negative effects on the quality of life, disorders of the lumbar spine represent a challenge in many aspects. Four out of five people will have lumbar pain sometime in their lifetime. Complete history and physical exam are still the diagnostic pillars of those disorders. 1 Imaging diagnostic methods and other tests are just complementary. Approximately 120 diseases affect the lumbar spine. Herniated lumbar disk is one of them. Lumbar pain, lumbosciatalgia, cruralgia, and sciatic pain represent the main symptoms. 2 Lasègue's sign, also called "straight leg raising" in English speaking countries, is the maneuver performed more often to detect mechanical compression and inflammation of lumbar nerve roots by protruding and extruding herniated disks. However, how it should be determined, its mechanism, and the true meaning of its clinical application are still surrounded

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Sinal de Cecin (Sinal "X"): um aprimoramento no diagnóstico de compressão radicular por hérnias discais lombares

Cecin¹

2010

Rev. Bras. Reumatol.

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“…Rest pain intensity on the day of investigation was determined based on the numerical rating scale 0–10 (NRS) by marking the current level of pain, whereas the level of nerve root irritation in the lumbar region of the spine was estimated using Lasegue's test (Summers et al., ).…”

Section: Methodsmentioning

confidence: 99%

Intensity of chronic pain modifies postural control in low back patients

Sipko¹,

Kuczyński

2012

European Journal of Pain

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“…They were blinded regarding patient history and clinical findings. The locations of the disc herniation were identified in the axial plane, and were categorised as being localised centrally or to the left or right in the spinal canal [30]. In cases of disagreement, a consensus was reached emphasising the most experienced.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of physical examination for chronic lumbar radiculopathy

Iversen

Solberg

Romner

et al. 2013

BMC Musculoskelet Disord

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BackgroundClinical examination of patients with chronic lumbar radiculopathy aims to clarify whether there is nerve root impingement. The aims of this study were to investigate the association between findings at clinical examination and nerve root impingement, to evaluate the accuracy of clinical index tests in a specialised care setting, and to see whether imaging clarifies the cause of chronic radicular pain.MethodsA total of 116 patients referred with symptoms of lumbar radiculopathy lasting more than 12 weeks and at least one positive index test were included. The tests were the straight leg raising test, and tests for motor muscle strength, dermatome sensory loss, and reflex impairment. Magnetic resonance imaging (n = 109) or computer tomography (n = 7) were imaging reference standards. Images were analysed at the level of single nerve root(s), and nerve root impingement was classified as present or absent. Sensitivities, specificities, and positive and negative likelihood ratios (LR) for detection of nerve root impingement were calculated for each individual index test. An overall clinical evaluation, concluding on the level and side of the radiculopathy, was performed.ResultsThe prevalence of disc herniation was 77.8%. The diagnostic accuracy of individual index tests was low with no tests reaching positive LR >4.0 or negative LR <0.4. The overall clinical evaluation was slightly more accurate, with a positive LR of 6.28 (95% CI 1.06–37.21) for L4, 1.74 (95% CI 1.04–2.93) for L5, and 1.29 (95% CI 0.97–1.72) for S1 nerve root impingement. An overall clinical evaluation, concluding on the level and side of the radiculopathy was also performed, and receiver operating characteristic (ROC) analysis with area under the curve (AUC) calculation for diagnostic accuracy of this evaluation was performed.ConclusionsThe accuracy of individual clinical index tests used to predict imaging findings of nerve root impingement in patients with chronic lumbar radiculopathy is low when applied in specialised care, but clinicians’ overall evaluation improves diagnostic accuracy slightly. The tests are not very helpful in clarifying the cause of radicular pain, and are therefore inaccurate for guidance in the diagnostic workup of the patients. The study population was highly selected and therefore the results from this study should not be generalised to unselected patient populations in primary care nor to even more selected surgical populations.

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Low Back Pain on Passive Straight Leg Raising

Abstract: Acute low back pain associated with significant restriction in SLR is likely to be caused by a disc prolapse compressing the anterior theca.

Cited by 18 publications

References 10 publications

Sinal de Cecin (Sinal "X"): um aprimoramento no diagnóstico de compressão radicular por hérnias discais lombares

Sinal de Cecin (Sinal "X"): um aprimoramento no diagnóstico de compressão radicular por hérnias discais lombares

Intensity of chronic pain modifies postural control in low back patients

Accuracy of physical examination for chronic lumbar radiculopathy

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