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Lumbar Spinal Stenosis
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History
The cluster of Cook are features on history to determine the probability of lumbar spinal stenosis.[1] The features on history are 1) bilateral symptoms; 2) leg pain more than back pain; 3) pain during walking/standing; 4) pain relief upon sitting; and 5) age>48 years. Having no findings has a sensitivity of 96%, with a negative likelihood ratio of 0.19. Having four of five findings has a sensitivity of 6%, and specificity of 98%, with a positive likelihood ratio of 4.6. Three of five findings had a higher sensitivity, but a lower LR+ of 2.5.
Examination
Test Name | LR+ | LR- | Sens | Spec | Kappa |
---|---|---|---|---|---|
Wide-based gait | 14 | 0.6 | 43% | 97% | |
Urinary disturbance | 7.0 | 0.9 | 14% | 98% | |
No pain when seated | 6.6 | 0.6 | 46% | 93% | |
Improvement when bending forward | 6.5 | 0.5 | 52% | 92% | |
Numbness of perineal region | 5.0 | 1.0 | 5% | 99% | |
Abnormal Romberg test | 4.3 | 0.7 | 39% | 91% | |
Neurogenic claudication | 3.7 | 0.2 | 82% | 78% | |
Symptoms improve when seated | 3.1 | 0.6 | 52% | 83% | |
Vibration deficit 1st metatarsal head | 2.8 | 0.6 | 53% | 81% | |
Pinprick deficit foot or calf | 2.5 | 0.7 | 47% | 81% | |
Age > 65 yrs | 2.5 | 0.3 | 77% | 69% | |
Weakness | 2.1 | 0.7 | 47% | 78% | |
Absent Achilles reflex | 2.1 | 0.7 | 46% | 78% | |
Bilateral plantar numbness | 2.1 | 0.8 | 27% | 87% | |
Severe lower-extremity pain | 2.0 | 0.5 | 65% | 67% | |
Thigh pain w/ 30 sec lumbar extension | 1.6 | 0.7 | 51% | 69% | |
Pain below knees | 1.5 | 0.7 | 56% | 63% | |
Numbness | 1.5 | 0.6 | 63% | 59% | |
Poor balance | 1.5 | 0.6 | 70% | 53% | |
No pain with flexion | 1.4 | 0.5 | 79% | 44% | |
Pain below buttocks | 1.3 | 0.4 | 88% | 34% | |
Worse when walking | 1.0 | 1.0 | 71% | 30% |