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Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study

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Abstract

Purpose

Reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis (LSS).

Methods

Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items. An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test. Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 15 members of Taskforce defined final list of 10 items. Round 3: Survey was distributed internationally, followed by Taskforce consensus.

Results

Totally, 432 clinicians from 28 different countries participated. Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty (p < 0.05). The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. The diagnostic test selected most frequently as the first test was neurological examination.

Conclusions

This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy. If applied, this core set of diagnostic tests can standardize outcomes and improve clinical care of LSS globally.

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Acknowledgements

The authors wish to acknowledge the International Society for the Study of the Lumbar Spine (ISSLS) for supporting our Taskforce as an ISSLS Focus Group. We would also like to acknowledge the following research societies for distributing our survey: ISSLS, International Spine Intervention Society, British Association of Spine Surgeons, British Scoliosis Society, Canadian Spine Society, Asia Pacific Orthopaedic Association, Hong Kong Orthopaedic Association, British Chiropractic Association, Taiwan Physical Therapy Association, Australian Chiropractors Association, International Society of Scoliosis, Orthopaedics and Rehabilitation Treatment, Associacoa Brasileira De Quiropraxia, Macau Physical Therapy Association, Korean Physiotherapy Association, Korean Society of Spine Surgery, Singapore Physiotherapy Association, Canadian Physiotherapy Association, Nepal Physiotherapy Association, United Kingdom Spine Societies Board, National Back Pain Clinical Network, Royal College of Chiropractors, and UK Advance Practice Physiotherapy Network.

This paper is the result of the work by the following group:

The International Taskforce on the Diagnosis and Management of Lumbar Spinal Stenosis; The International Society for the Study of the Lumbar Spine (ISSLS) Focus Group on Diagnosis and Management of Lumbar Spinal Stenosis. The following are members of the group who we would like to acknowledge.

Jon Lurie, MD, Dartmouth University, USA; Matt Smuck, MD, Stanford University, USA; Michele Battie, PhD, University of Alberta, Canada; Brian Freeman, MD, University of Adelaide, Australia; Dino Samartzis, MD, PhD, University of Hong Kong, Hong Kong; Thomas Barz, MD, Asklepios Gemeinsam für Gesundheit, Germany; Kent Stuber, DC, Canadian Memorial Chiropractic College, Canada; Michael Schneider, DC, PhD, University of Pittsburgh, USA; Andrew Haig, MD, University of Michigan, USA; Constantin Schizas, MD, University Hospital of Lausanne, Switzerland; Jason Cheung, MD, University of Hong Kong; Anne Mannion, PhD, Spine Center, Schulthess Klinik, Switzerland; Lukas Staub, MD, PhD, University of Berne, Switzerland; Christine Comer, PhD, Wharfedale General Hospital, UK; Luciana Macedo, PhD, University of Alberta, Canada; Sang-ho Ahn, Yeungnam University, South Korea; Kazuhisa Takahashi, MD, PhD, Chiba University, Japan; Jeremy Fairbank, MD, Oxford, UK; Amir Jamaludin, PhD, Oxford, UK; Hiroshi Hashizume, MD, PhD, Wakayama, Japan; Yuyu Ishimoto, MD, PhD, Wakayama, Japan; Naresh Kumar, MD, National University of Singapore, Singapore; Joseph Assheuer, MD, Stadt, Germany; Hans-Joachim Wilke, MD, Germany; Richard Hu, MD, Calgary, Canada.

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Authors and Affiliations

  1. Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6KG, Canada

    Christy Tomkins-Lane

  2. Zurich University of Applied Sciences, Winterthur, Switzerland

    Markus Melloh

  3. Hong Kong Polytechnic University, Kowloon, Hong Kong

    Arnold Wong

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  1. Christy Tomkins-Lane
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Correspondence to Christy Tomkins-Lane.

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Tomkins-Lane, C., Melloh, M. & Wong, A. Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study. Eur Spine J 29, 2188–2197 (2020). https://doi.org/10.1007/s00586-020-06481-w

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