Skip to main content
SpringerLink
Log in

A critical assessment of clinical diagnosis of disc herniation in patients with monoradicular sciatica

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The diagnostic power or clinical parameters in the diagnosis of lumbar disc herniation in patients with monoradicular pain was evaluated in a prospective study with a 100% verification of the diagnosis.

Eighty patients with monoradicular pain corresponding to the fifth lumbar or the first sacral nerve root were included. Pre-operatively a number of clinical parameters were recorded and compared to the intra-operative finding of a disc herniation. The parameters were analysed by receiver operating characteristic (ROC) curves. Results from the available literature were analysed by ROC curves for comparison.

In 76% of the cases a disc herniation was discovered. The level of the disc herniation was correctly predicted in 93% of these cases by the location of the pain alone or supplemented by neurological signs. Apart from radicularly distributed pain, all parameters in the present study and in the literature had no or low diagnostic accuracy.

Thus, in patients with monoradicular sciatica further clinical parameters do not add to the diagnosis of lumbar disc herniation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beam CA, Sostman HD, Zheng J-Y (1991) Status of clinical MR evaluations 1985–1988: baseline and design for further assessments. Radiology 180: 265–270

    PubMed  Google Scholar 

  2. Blower PW (1981) Neurological patterns in unilateral sciatica. A prospective study of 100 new cases. Spine 6: 175–179

    PubMed  Google Scholar 

  3. Centor RM, Schwartz JS (1985) An evaluation of methods for estimating the area under the receiver operating characteristic (ROC) curve. Med Decis Making 5: 149–156

    PubMed  Google Scholar 

  4. Cooper LS, Chalmers TC, McCally M, Berrier J, Sacks HS (1988) The poor quality of early evaluations of magnetic resonance imaging. JAMA 22: 3277–3280

    Google Scholar 

  5. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain. JAMA 268: 760–765

    PubMed  Google Scholar 

  6. Deyo RA, Tsui-wu YJ (1987) Descriptive epidemiology of low back pain and its related medical care in the United States. Spine 12: 264–268

    PubMed  Google Scholar 

  7. Edgar MA, Park WM (1974) Induced pain patterns on passive straight leg raising in lower lumbar disc protrusion. J Bone Joint Surg 56B: 658–667

    Google Scholar 

  8. Finneson BE, Cooper VR (1979) A lumbar disc surgery predictive score card. A retrospective evaluation. Spine 4: 141–144

    PubMed  Google Scholar 

  9. Finsterbush A, Frankel U, Pharm B, Arnon R (1983) Quantitative power measurement of extensor hallucis longus. Spine 8: 206–210

    PubMed  Google Scholar 

  10. Friis ML, Gulliksen GC, Rasmussen P, Husby J (1977) Pain and spinal root compression. Acta Neurochir (Wien) 39: 241–249

    Google Scholar 

  11. Hakelius A, Hindmarsh J (1972) The comparative reliability of preoperative diagnostic methods in lumbar disc surgery. Acta Orthop Scand 43: 234–238

    PubMed  Google Scholar 

  12. Hakelius A, Hindmarsh H (1972) The significance of neurological signs and myelographic findings in the diagnosis of lumbar root compression. Acta Orthop Scand 43: 239–246

    PubMed  Google Scholar 

  13. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29–36

    PubMed  Google Scholar 

  14. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148: 839–843

    PubMed  Google Scholar 

  15. Herron LR, Turner J (1985) Patient selection for lumbar laminectomy and discectomy with a revised objective rating system. Clin Orthop 199: 145–152

    PubMed  Google Scholar 

  16. Jensen OH (1987) The level-diagnosis of a lower lumbar disc herniation: the value of sensibility and motor testing. Clin Rheumatol 6(4): 564–569

    PubMed  Google Scholar 

  17. Khuffash B, Porter RW (1989) Cross leg pain and trunk list. Spine 14: 602–603

    PubMed  Google Scholar 

  18. Kortelainen P, Puranen J, Koivisto E, Lähde S (1985) Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine 10: 88–92

    PubMed  Google Scholar 

  19. Kosteljanetz M, Espersen JO, Halaburt H, Miletic T (1984) Predictive value of clinical and surgical findings in patients with lumbago-sciatica. A prospective study (Part I). Acta Neurochir (Wien) 73: 67–76

    Google Scholar 

  20. Metz CE (1978) Basic principles of ROC analysis. Semin Nucl Med 8: 283–298

    PubMed  Google Scholar 

  21. Porter RW, Miller CG (1986) Back pain and trunk list. Spine 11: 596–600

    PubMed  Google Scholar 

  22. Spangfort EV (1972) The lumbar disc herniation. Acta Orthop Scand [Suppl] 142: 1–95

    Google Scholar 

  23. Spengler DM, Freeman CW (1979) Patient selection for lumbar disctomy. Spine 4: 129–134

    Google Scholar 

  24. Swets JA (1979) ROC analysis applied to the evaluation of medical imaging techniques. Invest Radiol 14: 109–120

    PubMed  Google Scholar 

  25. Ud'n A, Landin LA (1987) Pain drawing and myelography in sciatic pain. Clin Orthop 216: 124–130

    PubMed  Google Scholar 

  26. Weise MD, Garfin SR, Gelberman RH, Katz MM, Thorne RP (1985) Lower-extremity sensibility testing in patients with herniated lumbar intervertebral discs. J Bone Joint Surg 67A: 1219–1224

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Clinic of Neurosurgery, Rigshospitalet, Copenhagen

    M. J. Albeck M.D.

Authors
  1. M. J. Albeck M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Albeck, M.J. A critical assessment of clinical diagnosis of disc herniation in patients with monoradicular sciatica. Acta neurochir 138, 40–44 (1996). https://doi.org/10.1007/BF01411722

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01411722

Keywords

Search

Navigation