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Lumbar Spinal Stenosis: Difference between revisions
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==History== | ==History== | ||
The cluster of Cook are features on history to determine the probability of lumbar spinal stenosis.{{#pmid:21077266|cook}} 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. | The cluster of Cook are features on history to determine the probability of lumbar spinal stenosis.{{#pmid:21077266|cook}} 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== | |||
{| class="wikitable sortable" | |||
|- | |||
!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% || | |||
|} | |||
==References== | ==References== | ||
Revision as of 11:43, 18 August 2020
This article is a stub.
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% |
