Predictive value of self-reported patient information for the identification of lumbar spinal stenosis

Sugioka, Takashi; Hayashino, Yasuaki; Konno, Satoshi; Kikuchi, Shinichi; Fukuhara, Shunichi

doi:10.1093/fampra/cmn031

Cited by 41 publications

(43 citation statements)

References 30 publications

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“…In adults with back pain and numbness in the lower extremities, lumbar stenosis is present in 47% of cases (Pretest probability) 5 . A reported LR+ of 3,7 for a positive clinical findings 6 , this patient has a probability of 76% of having spinal stenosis.…”

Section: Case Oriented Evidence and Resultsmentioning

confidence: 99%

Axonal, bladder and bowel impairment: evidence based clinical review of gaps in guidelines for spinal stenosis

Giraldo-Prieto¹

2015

Rev Col Med Fis Reh

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The axonal damage of sacral roots, the bladder dysfunction and constipation that slowly progress in severe cases of spinal stenosis, are not assessed in literature of high scientific evidence. The decision-making process to choose interventions lacks of guidance to confirm the presence of these three conditions, their natural evolution, impact on quality of life and functionality, and its management. The symptom of pain and the wait for an advanced loss of motor function seem to be the criteria that determine the follow up in spinal stenosis, although the guidelines and systematic reviews show a limited effect of exercise or medication. The usefulness of electrodiagnostic studies is compared with that of MRI to diagnose spinal stenosis, limiting their true diagnosis power. This article suggests an alternate use of these two diagnostic tests, using the Bayes Theorem, the Fagan nomogram and the pre test and post test likelihood ratios to confirm the presence of axonal destruction by paraspinal electromyography and the tibial nerve H reflex, as a complement to a positive MRI for lumbar stenosis. With the same method, the bladder ultrasound and urodynamics are evaluated to confirm bladder dysfunction. A case of spinal stenosis exemplify the guidelines follow up, the functional decline and the proposal to use tools of scientific evidence to broaden the evidence in decision making for best judgment on spinal stenosis

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Section: Case Oriented Evidence and Resultsmentioning

confidence: 99%

Axonal, bladder and bowel impairment: evidence based clinical review of gaps in guidelines for spinal stenosis

Giraldo-Prieto¹

2015

Rev Col Med Fis Reh

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“…Four recent studies [30][31][32][33] have examined symptomatic presentation of patients with LSS, and the results of these studies were reviewed in a meta-analysis (n = 741) by Suri and colleagues. 4 The study population was not limited to patients with specific reports of intermittent claudication; rather, patients presenting with LBP and/or lower extremity pain were included.…”

Section: Discussionmentioning

confidence: 99%

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

Nadeau

Rosas‐Arellano

Gurr

et al. 2013

CJS

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Background: Intermittent claudication can be neurogenic or vascular. Physicians use a profile based on symptom attributes to differentiate the 2 types of claudication, and this guides their investigations for diagnosis of the underlying pathology. We evaluated the validity of these symptom attributes in differentiating neurogenic from vascular claudication. Methods:Patients with a diagnosis of lumbar spinal stenosis (LSS) or peripheral vascular disease (PVD) who reported claudication answered 14 questions characterizing their symptoms. We determined the sensitivity, specificity and positive and negative likelihood ratios (PLR and NLR) for neurogenic and vascular claudication for each symptom attribute. Results:We studied 53 patients. The most sensitive symptom attribute to rule out LSS was the absence of "triggering of pain with standing alone" (sensitivity 0.97, NLR 0.050). Pain alleviators and symptom location data showed a weak clinical significance for LSS and PVD. Constellation of symptoms yielded the strongest associations: patients with a positive shopping cart sign whose symptoms were located above the knees, triggered with standing alone and relieved with sitting had a strong likelihood of neurogenic claudication (PLR 13). Patients with symptoms in the calf that were relieved with standing alone had a strong likelihood of vascular claudication (PLR 20.0). Conclusion:The classic symptom attributes used to differentiate neurogenic from vascular claudication are at best weakly valid independently. However, certain constellation of symptoms are much more indicative of etiology. These results can guide general practitioners in their evaluation of and investigation for claudication.Contexte : La claudication intermittente peut avoir une étiologie neurogène ou vasculaire. Les médecins utilisent un profil fondé sur les particularités des symptômes pour distinguer l'une de l'autre et ceci oriente leur choix des méthodes de diagnostic de la pathologie sous-jacente. Nous avons évalué la validité de ces particularités des symptômes utilisées pour distinguer la claudication d'origine neurogène de la claudication d'origine vasculaire. Méthodes :Des patients atteints d'une sténose spinale lombaire (SSL) ou d'une maladie vasculaire périphérique (MVP) avérées qui se plaignaient de claudication ont répondu à 14 questions afin de caractériser leurs symptômes. Nous avons déterminé la sensibilité, la spécificité et les rapports de probabilité positifs et négatifs (RPP et RPN) à l'égard de la claudication neurogène ou vasculaire pour chacune des particularités des symptômes.Résultats : Notre étude a regroupé 53 patients. La particularité des symptômes dotée de la sensibilité la plus élevée pour ce qui est d'écarter le diagnostic de SSL a été l'absence de « déclenchement de la douleur à la simple station debout » (sensibilité 0,97; RPN 0,050). Les données sur ce qui soulageait la douleur et sur la localisation des symptômes ont eu une faible portée clinique en ce qui a trait à la SSL et à la MVP. La présence d'une constellati...

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“…However, there is no standard diagnostic tool for lumbar spinal stenosis and discrepancies between clinical symptoms and imaging findings are common [8]. A patient's complaints about the pain distribution may be the only meaningful parameter [9,10]. Thus, it is important but difficult to diagnose the ''true clinical stenosis patient.''…”

Section: Discussionmentioning

confidence: 99%

Quadriceps muscle rupture mimicking lumbar radiculopathy

et al. 2012

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Study design Case report. Objective To report an unusual case of vastus lateralis muscle rupture not accompanied by any history of major trauma or the presence of a risk factor in a patient with spinal stenosis. Summary of background data Isolated vastus lateralis muscle rupture without an obvious cause is very rare. Localized pain and claudication are the most common symptoms and can be misdiagnosed as lumbar radiculopathy. Methods A 70-year-old patient presented with right lower extremity and back pain, diagnosed as spinal stenosis. He was initially treated with caudal epidural block and transforaminal epidural block, which resulted in nearly complete relief of his symptoms. However, he subsequently experienced a pain that was no longer responsive to treatment. The ultrasonographic exam revealed a partial tear of the right vastus lateralis muscle. Result Injection of local anesthetics relieved the patient's symptoms. At 1-month follow-up, he remained pain-free. Conclusions In patients with lower back and leg pain, physicians should consider non-spinal conditions that can cause signs and symptoms mimicking lumbar radiculopathy.

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Predictive value of self-reported patient information for the identification of lumbar spinal stenosis

Abstract: We developed a prediction rule for the identification of LSS based on self-reported patient information alone. Further, the likelihood ratio in the low-risk category was sufficiently low. This rule may be used for screening of LSS.

Cited by 41 publications

References 30 publications

Axonal, bladder and bowel impairment: evidence based clinical review of gaps in guidelines for spinal stenosis

Axonal, bladder and bowel impairment: evidence based clinical review of gaps in guidelines for spinal stenosis

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

Quadriceps muscle rupture mimicking lumbar radiculopathy

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