<p>Diagnostic Screening for Lumbar Spinal Stenosis</p>

Abstract

Purpose: To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items. Patients and Methods: A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire. Results: A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%. Conclusion: The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes.

Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program

“…Currently, there is no consensus criterion standard for the diagnosis of LSS [ 1 , 5 , 25 ] and thus, varying LSS case definitions have been used in previous studies [ 42 ], none of which have been validated. The specific symptom items used in this study were derived from a review of commonly used self-report LSS screening items [ 22 ] and include those most likely to identify LSS [ 25 ]. We expect that the term “numbness” in the symptom items is distinct and therefore noticeably different for people with knee or hip OA, therefore improving one's ability to differentiate LSS symptoms from knee- or hip-related symptoms.…”

“…Participants were classified as having comorbid LSS symptoms if they reported: 1) “sometimes feeling pain or numbness in one/both legs or buttocks (meaning other symptoms than from the knee or hip joint)”; 2) at least one symptom-worsening activity (walking or standing for a while); at least one symptom-relieving activity (bending forwards; sitting; riding a bicycle; or bending over a shopping cart); 3) not having diabetes; and 4) were aged 60 years or older (see Supplementary File for full details on classification). The individual LSS symptom items are commonly used self-report items that distinguish other types of leg pain from LSS [ 22 ]. The age cut-point of 60 years or older was selected to decrease the probability of leg pain due to lumbar disc herniation and has been used in previous criteria for LSS [ 23 , 24 ].…”

“…The no diabetes criteria was included to ensure participants with diabetic neuropathy, an important differential diagnosis for symptomatic LSS in people over 60, 23 were not included. Low back pain was not included in the LSS symptom definition because it is not considered a key feature of LSS or necessary for diagnosis, due to the fact many individuals with LSS do not report back pain [ 5 , 22 , 25 ]. The LSS symptom items and diabetic status were collected at baseline via electronic self-report questions and age was calculated using the 10-digit person-unique Central Person Registry number assigned to all people residing in Denmark.…”

Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review

“…Lumbar spinal stenosis (LSS) is defined as the narrowing of the spinal canal that is associated with subsequent neurovascular impingement and emergence of clinical symptomatology. [1][2][3] LSS may be divided into 3 distinct subcategories according to anatomic representation: central stenosis (CS), lateral recess stenosis (LRS), and foraminal stenosis (FS), with especial clinical implications in each case. 2,4 Development of LSS may be robustly attributed to congenital, degenerative, or miscellaneous conditions.…”

“…[1][2][3] LSS may be divided into 3 distinct subcategories according to anatomic representation: central stenosis (CS), lateral recess stenosis (LRS), and foraminal stenosis (FS), with especial clinical implications in each case. 2,4 Development of LSS may be robustly attributed to congenital, degenerative, or miscellaneous conditions. 5 LSS is often characterized by the complete absence of symptoms, demonstrating an insidious evolution.…”