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Lumbar Spinal Stenosis: Difference between revisions
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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. | ||
== | ==Clinical Assessment== | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|+Determine the likelihood of a patient having a disease based on information gathered during a history and physical evaluation.<ref>{{#pmid:7575718}}</ref> | |||
|- | |- | ||
!Test Name!!LR+!!LR-!!Sens!!Spec!!Kappa | !Test Name!!LR+!!LR-!!Sens!!Spec!!Kappa | ||
Revision as of 11:44, 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.
Clinical Assessment
| 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
- ↑ Cook et al.. The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiotherapy research international : the journal for researchers and clinicians in physical therapy 2011. 16:170-8. PMID: 21077266. DOI.
- ↑ Katz et al.. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis and rheumatism 1995. 38:1236-41. PMID: 7575718. DOI.
