Advertisement

Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal stenosis

  • Christian Jaeger Cook
  • Chad E. Cook
  • Michael P. Reiman
  • Anand B. Joshi
  • William Richardson
  • Alessandra N. GarciaEmail author
Review Article

Abstract

Purpose

To update evidence of diagnostic potential for identification of lumbar spinal stenosis (LSS) based on demographic and patient history, clinical findings, and physical tests, and report posttest probabilities associated with test findings.

Methods

An electronic search of PubMed, CINAHL and Embase was conducted combining terms related to low back pain, stenosis and diagnostic accuracy. Prospective or retrospective studies investigating diagnostic accuracy of LSS using patient history, clinical findings and/or physical tests were included. The risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS 2) tool. Diagnostic accuracy including sensitivities (SN), specificities (SP), likelihood ratios (+LR and −LR) and posttest probabilities (+PTP and −PTP) with 95% confidence intervals were summarized.

Results

Nine studies were included (pooled n = 36,228 participants) investigating 49 different index tests (30 demographic and patient history and 19 clinical findings/physical tests). Of the nine studies included, only two exhibited a low risk of bias and seven exhibited good applicability according to QUADAS 2. The demographic and patient history measures (self-reported history questionnaire, no pain when seated, numbness of perineal region) and the clinical findings/physical tests (two-stage treadmill test, symptoms after a March test and abnormal Romberg test) highly improved positive posttest probability by > 25% to diagnose LSS.

Conclusion

Outside of one study that was able to completely rule out LSS with no functional neurological changes none of the stand-alone findings were strong enough to rule in or rule out LSS.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Accuracy Diagnostic Low back pain Stenosis Systematic review 

Notes

Compliance with ethical standards

Conflict of interest statement

The authors declare that there is no conflict of interest.

Supplementary material

586_2019_6048_MOESM1_ESM.pptx (139 kb)
Supplementary material 1 (PPTX 139 kb)

References

  1. 1.
    Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358(8):818–825.  https://doi.org/10.1056/nejmcp0708097 CrossRefGoogle Scholar
  2. 2.
    Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (2009) Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J 9(7):545–550.  https://doi.org/10.1016/j.spinee.2009.03.005 CrossRefGoogle Scholar
  3. 3.
    Singh K, Samartzis D, Vaccaro AR, Nassr A, Andersson GB, Yoon ST, Phillips FM, Goldberg EJ, An HS (2005) Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis. Spine J 5(6):615–622.  https://doi.org/10.1016/j.spinee.2005.05.385 CrossRefGoogle Scholar
  4. 4.
    De Villiers PD, Booysen EL (1976) Fibrous spinal stenosis. A report on 850 myelograms with a water-soluble contrast medium. Clin Orthop Relat Res 115:140–144Google Scholar
  5. 5.
    Roberson GH, Llewellyn HJ, Taveras JM (1973) The narrow lumbar spinal canal syndrome. Radiology 107(1):89–97.  https://doi.org/10.1148/107.1.89 CrossRefGoogle Scholar
  6. 6.
    Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN (2000) The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine (Phila Pa 1976) 25(12):1509–1514CrossRefGoogle Scholar
  7. 7.
    de Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B (2006) Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976) 31(10):1168–1176.  https://doi.org/10.1097/01.brs.0000216463.32136.7b CrossRefGoogle Scholar
  8. 8.
    de Schepper EI, Overdevest GM, Suri P, Peul WC, Oei EH, Koes BW, Bierma-Zeinstra SM, Luijsterburg PA (2013) Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine 38(8):E469–E481.  https://doi.org/10.1097/brs.0b013e31828935ac CrossRefGoogle Scholar
  9. 9.
    Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8(25):1–234CrossRefGoogle Scholar
  10. 10.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, Group Q (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536.  https://doi.org/10.7326/0003-4819-155-8-201110180-00009 CrossRefGoogle Scholar
  11. 11.
    McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319(4):388–396.  https://doi.org/10.1001/jama.2017.19163 CrossRefGoogle Scholar
  12. 12.
    Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008.  https://doi.org/10.1136/bmj.j4008 CrossRefGoogle Scholar
  13. 13.
    Bossuyt P, Leeflang M (2008) Chapter 6: developing criteria for including studies. Cochrane handbook for systematic reviews of diagnostic test accuracy version 04 [updated September 2008] The Cochrane CollaborationGoogle Scholar
  14. 14.
    Worster A, Carpenter C (2008) Incorporation bias in studies of diagnostic tests: how to avoid being biased about bias. Can J Emerg Med 10(2):174–175Google Scholar
  15. 15.
    Wayne J (2005) Mosby’s dicfionary of complementary & alternafive medicine. Mosby, St LouisGoogle Scholar
  16. 16.
    Harris P, Nagy S, Vardaxis N (2014) ) Mosby’s Dictionary of Medicine, Nursing and Health Professions-Australian & New Zealand Edition. Elsevier Health Sciences, AmsterdamGoogle Scholar
  17. 17.
    Bossuyt PM, Reitsma JB, Linnet K, Moons KG (2012) Beyond diagnostic accuracy: the clinical utility of diagnostic tests. Clin Chem 58(12):1636–1643.  https://doi.org/10.1373/clinchem.2012.182576 CrossRefGoogle Scholar
  18. 18.
    Cook C, Hegedus EJ (2008) Orthopedic physical examination tests: an evidence-based approach. Prentice Hall, New YorkGoogle Scholar
  19. 19.
    Toolbox E-BM (2018) EBM calculators. https://ebm-tools.knowledgetranslation.net/calculator
  20. 20.
    Analysis wCT (2018) 2-way contingency table analysis. http://statpages.info/ctab/2x2.html
  21. 21.
    Calculation E (2018) Diagnostic post test probability of disease calculation. https://www.easycalculation.com/statistics/post-test-probability.php
  22. 22.
    Cook C, Brown C, Michael K, Isaacs R, Howes C, Richardson W, Roman M, Hegedus E (2011) The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiother Res Int 16(3):170–178.  https://doi.org/10.1002/pri.500 CrossRefGoogle Scholar
  23. 23.
    Dobbs R, May S, Hope P (2016) The validity of a clinical test for the diagnosis of lumbar spinal stenosis. Man Ther 25:27–34.  https://doi.org/10.1016/j.math.2016.05.332 CrossRefGoogle Scholar
  24. 24.
    Fritz JM, Erhard RE, Delitto A, Welch WC, Nowakowski PE (1997) Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. J Spinal Disord 10(5):410–416CrossRefGoogle Scholar
  25. 25.
    Jensen OH, Schmidt-Olsen S (1989) A new functional test in the diagnostic evaluation of neurogenic intermittent claudication. Clin Rheumatol 8(3):363–367CrossRefGoogle Scholar
  26. 26.
    Kato K, Sekiguchi M, Yonemoto K, Kakuma T, Nikaido T, Watanabe K, Otani K, Yabuki S, Kikuchi S, Konno S (2015) Diagnostic accuracy of the Self-administered, Self-reported History Questionnaire for lumbar spinal stenosis patients in Japanese primary care settings: a multicenter cross-sectional study (DISTO-project). J Orthop Sci 20(5):805–810.  https://doi.org/10.1007/s00776-015-0740-6 CrossRefGoogle Scholar
  27. 27.
    Katz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, Chang LC, Lipson SJ (1995) Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum 38(9):1236–1241CrossRefGoogle Scholar
  28. 28.
    Konno S, Hayashino Y, Fukuhara S, Kikuchi S, Kaneda K, Seichi A, Chiba K, Satomi K, Nagata K, Kawai S (2007) Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J 16(11):1951–1957.  https://doi.org/10.1007/s00586-007-0402-2 CrossRefGoogle Scholar
  29. 29.
    Roach KE, Brown MD, Albin RD, Delaney KG, Lipprandi HM, Rangelli D (1997) The sensitivity and specificity of pain response to activity and position in categorizing patients with low back pain. Phys Ther 77(7):730–738CrossRefGoogle Scholar
  30. 30.
    Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S (2008) Predictive value of self-reported patient information for the identification of lumbar spinal stenosis. Fam Pract 25(4):237–244.  https://doi.org/10.1093/fampra/cmn031 CrossRefGoogle Scholar
  31. 31.
    Simel DL, Rennie D (2016) Low back pain, lumbar spinal stenosis. In: The rational clinical examination: evidence-based clinical diagnosis. McGraw-Hill Education, New York, NY,Google Scholar
  32. 32.
    O’Connell NE, Cook CE, Wand BM, Ward SP (2016) Clinical guidelines for low back pain: a critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol 30(6):968–980.  https://doi.org/10.1016/j.berh.2017.05.001 CrossRefGoogle Scholar
  33. 33.
    Rutjes AW, Reitsma JB, Di Nisio M, Smidt N, van Rijn JC, Bossuyt PM (2006) Evidence of bias and variation in diagnostic accuracy studies. CMAJ 174(4):469–476.  https://doi.org/10.1503/cmaj.050090 CrossRefGoogle Scholar
  34. 34.
    Leeflang MM, Deeks JJ, Takwoingi Y, Macaskill P (2013) Cochrane diagnostic test accuracy reviews. Systematic reviews 2(1):82CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of BiologyUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Orthopaedic Surgery, Division of Physical Therapy, Duke Clinical Research InstituteDuke University School of MedicineDurhamUSA
  3. 3.Department of Orthopaedic Surgery, Division of Physical TherapyDuke University School of MedicineDurhamUSA
  4. 4.Department of Orthopaedic SurgeryDuke University School of MedicineDurhamUSA
  5. 5.Department of Orthopaedic Surgery and Neurosurgery, Spine DivisionDuke University School of MedicineDurhamUSA
  6. 6.Department of Orthopaedic Surgery, Division of Physical TherapyDuke University School of MedicineDurhamUSA

Personalised recommendations