ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis

Abstract

Study Design Delphi. Objective Obtain an expert consensus on which history factors are most important in the clinical diagnosis of LSS. Summary of Background Data Lumbar spinal stenosis (LSS) is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians. Methods Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An on-line survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting. Results 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were “leg or buttock pain while walking”, “flex forward to relieve symptoms”, “feel relief when using a shopping cart or bicycle”, “motor or sensory disturbance while walking”, “normal and symmetric foot pulses”, “lower extremity weakness” and “low back pain”. Significant change in certainty ceased after 6 questions at 80% (p<.05). Conclusions This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of “7 history items” that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes.

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

“…The overall prevalence of lumbar spinal stenosis varies among studies. The prevalence in the group based on clinical diagnostic criteria has been reported to be approximately 11% in the general population [ 13 - 15 ]. According to the diagnosis based on imaging studies, the prevalence was found to be 11% in the asymptomatic general population and 38% in the general population.…”

“…Till date, there exists some ambiguity in the clinical diagnostic criteria for degenerative lumbar spinal stenosis. According to a study conducted in 2016, the consensus of experts on clinical symptoms included (1) pain in the lower extremities or buttocks while walking, (2) symptom relief resulting from bending the lower back forward, (3) symptom relief from bending the back forward while using a shopping cart or riding a bicycle, (4) motor or sensory disturbance while walking, (5) normal and symmetrical pulse of the dorsalis pedis artery, (6) weakening of lower extremity, and (7) lower back pain [ 13 , 14 ]. In other studies, detailed history, gait, and some physical examination findings were also included in the classification criteria [ 13 , 15 , 19 ].…”

Informed appropriate imaging for low back pain management: A narrative review

“…As with disc herniations, stenosis is common in asymptomatic persons (4%–28%) [100] , [101] . The diagnosis of the clinical syndrome of lumbar spinal stenosis requires both the presence of characteristic symptoms and signs as well as imaging confirmation of narrowing of the lumbar spinal canal or foramina [102] .…”

Is annular repair technique useful for reducing reherniation and reoperation after limited discectomy

“…Thus, attempts to reduce the recurrent herniation have been tried again and again, and annular repair may be an answer. First reported by Yasargil in 1977 [22] and subsequently by others [23,24], the annular repair is considered as a valuable method to close the defect and subsequently prevent recurrent herniation.…”