| Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? | |
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MedLine Citation:
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PMID: 21156951 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adults presenting with lower extremity pain. OBJECTIVE: To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. DATA SOURCES: MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. STUDY SELECTION: Studies were included if they contained adequate data on the accuracy of the history and physical examination for diagnosing the clinical syndrome of LSS, using a reference standard of expert opinion with radiographic or anatomic confirmation. DATA EXTRACTION: Two authors independently reviewed each study to determine eligibility, extract data, and appraise levels of evidence. DATA SYNTHESIS: Four studies evaluating 741 patients were identified. Among patients with lower extremity pain, the likelihood of the clinical syndrome of LSS was increased for individuals older than 70 years (likelihood ratio [LR], 2.0; 95% confidence interval [CI], 1.6-2.5), and was decreased for those younger than 60 years (LR, 0.40; 95% CI, 0.29-0.57). The most useful symptoms for increasing the likelihood of the clinical syndrome of LSS were having no pain when seated (LR, 7.4; 95% CI, 1.9-30), improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1-9.9), the presence of bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1-13), and neurogenic claudication (LR, 3.7; 95% CI, 2.9-4.8). Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17-0.31) decreased the likelihood of the diagnosis. A wide-based gait (LR, 13; 95% CI, 1.9-95) and abnormal Romberg test result (LR, 4.2; 95% CI, 1.4-13) increased the likelihood of the clinical syndrome of LSS. A score of 7 or higher on a diagnostic support tool including history and examination findings increased the likelihood of the clinical syndrome of LSS (LR, 3.3; 95% CI, 2.7-4.0), while a score lower than 7 made the diagnosis much less likely (LR, 0.10; 95% CI, 0.06-0.16). CONCLUSIONS: The diagnosis of the clinical syndrome of LSS requires the appropriate clinical picture and radiographic findings. Absence of pain when seated and improvement of symptoms when bending forward are the most useful individual findings. Combinations of findings are most useful for identifying patients who are unlikely to have the diagnosis. |
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Authors:
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Pradeep Suri; James Rainville; Leonid Kalichman; Jeffrey N Katz |
Publication Detail:
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Type: Case Reports; Clinical Conference; Journal Article; Research Support, N.I.H., Extramural; Review |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 304 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-15 Completed Date: 2010-12-16 Revised Date: 2012-02-17 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2628-36 Citation Subset: AIM; IM |
Affiliation:
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Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital and VA Boston Healthcare System, Boston, Massachusetts 02114, USA. psuri@partners.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Female Humans Lower Extremity / physiopathology Lumbar Vertebrae Male Medical History Taking Pain / etiology* Physical Examination Spinal Stenosis / complications, diagnosis* Syndrome |
| Grant Support | |
ID/Acronym/Agency:
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K12 HD 01097/HD/NICHD NIH HHS; K24 AR 02124/AR/NIAMS NIH HHS; K24 AR002123-10/AR/NIAMS NIH HHS; P60 AR 47782/AR/NIAMS NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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