How useful is the clinical examination in lumbar spinal stenosis?

January 01, 0001

How useful is the clinical examination in lumbar spinal stenosis?

Lumbar spinal stenosis (LSS)is increasingly being recognized as a cause of low back and leg pain. These US and Israeli researcher endeavored to systematically review the accuracy of the clinical examination for the diagnosing LSS. They searched MEDLINE, EMBASE, and CINAHL Four studies evaluating 741 patients were identified where the clinical findings were compared with radiological data and expert opinion.

The researchers found: "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

The researchers concluded: "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."

Provides good clinical exam nuggets for the diagnosis of lumbar spinal stenosis.

For the full abstract, click here.

JAMA 304(23):2628-2636, 15 December 2010
© 2010 to the American Medical Association
Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis. Pradeep Suri, James Rainville, Leonid Kalichman, Jeffrey N. Katz.

Category: M. Musculoskeletal. Keywords: lumbar spinal stenosis, clinical examination, history, neurogenic claudication, psuedoclaudication, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 7 January 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.