Summary
Sensibility and motor power were prospectively tested in 52 consecutive hospitalized patients with a lower lumbar disc herniation, verified by operation. The test results were noted in a decision matrix, and the positive and negative predictive values were calculated. The positive predictive value of disturbed sensation in the L5 dermatome, paresis of dorsiflexion of the foot and extension of the 4 lateral toes as signs of a herniation from the fourth lumbar disc was calculated to be 76 per cent, 69 per cent and 76 per cent, respectively, and the negative predictive value in each case to be approximately 50 per cent. The positive predictive value of altered sensibility in the S1 dermatome as a sign of a herniation from the fifth lumbar disc was found to be 50 per cent and the negative predictive value to be 62 per cent. It is concluded, that these tests very often give diagnostically specific information in patients with a herniation from the fourth lumbar disc and should therefore be performed if a lumbar root compression is suspected. They are, however, of limited value in the case of a protrusion from the fifth lumbar disc.
Similar content being viewed by others
References
Bischoff, W., Nittner, K. Zur klinik und operativen behandlung des lumbalen bandscheibenvorfalls. Neurochirurgia (Stuutg.) (In German) 1969, 12, 43–69.
Blower, P.W. Neurologic patterns in unilateral sciatica. A prospective study of loo new cases. Spine 1981, 6, 175–179.
Brown, H.A., Pont, M.E. Disease of lumbar discs. J Neurosurg 1963, 20, 410–417.
Busch, E., Andersen, A, Broager, B. et al. Den lumbale diskusprolaps. Ugeskr Laeger (In Danish) 1949, 111, 165–188.
Falconer, M.A., Glasgow, G.L., Cole, D.S. Sensory disturbances occurring in sciatica due to intervertebral disc protrusions: Some observations of the fifth lumbar and first sacral dermatomes. J Neurol Neurosurg Psychiatr 1947, 10–11, 72–74.
Gurdjian, E.S., Webster, J.E., Ostrowski, A.Z. et al.: Herniated lumbar intervertebral discs. An analysis of 1176 operated cases. J Trauma 1961, 1, 158–176.
Kortelainen, P., Puranen, J., Koivisto, E. et al. Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine 1985, 10, 88–92.
Malmros, R. Clinical syndromes in protrusion of lumbar intervertebral discs. Acta Neurol Psychiatr Scand 1956, suppl. 108, 255–264.
Medical Research Council Aids to the investigation of peripheral nerve injuries. War Memorandum No. 7. Revised second edition. London, Her Majesty's Stationary Office, 1943.
Norlén, G. On the value of the neurological symptoms in sciatica for the localization of a lumbar disc herniation. Acta Chir Scand 1944, suppl. 95.
O'Connell, J.E.A. Protrusions of the lumbar intervertebral discs. J Bone Jt Surg 1951, 33B, 8–30.
Postacchini, F., Ripani, M., Carpano, S. Morphometry of the lumbar vertebrae. An anatomic study in two caucasoid ethnic groups. Clin Orthop 1983, 172, 296–303.
Raaf, J. Some observations regarding 905 patients operated upon for protruded lumbar intervertebral disc. Am J Surg 1959, 97, 388–399.
Spangfort, E.V. The lumbar disc herniation: A computer-aided analysis of 2504 operations. Acta Orthop Scand 1972, suppl. 142.
Spurling, R. G., Brandford, F.K. Neurologic aspects of herniated nucleus pulposus. JAMA 1939, 113, 2019–2022.
Ståhl, F. Clinical diagnosis of lumbar disc protrusion. Acta Orthop Scand 1949, 18, 141–152.
Troupp, H., Ulfves, A. Level of diagnosis of lumbar disc protrusion. Nord Med (In Swedish) 1959, 62, 1144–1146.
Weber, H. Lumbar disc herniation. A prospective study of prognostic factors including a controlled trial. Part 1. J Oslo City Hosp 1978, 28, 33–64.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jensen, O.H. The level-diagnosis of a lower lumbar disc herniation: The value of sensibility and motor testing. Clin Rheumatol 6, 564–569 (1987). https://doi.org/10.1007/BF02330594
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02330594