The Clinical Significance of Straight-Leg Raising (Lasègueʼs Sign) in the Diagnosis of Prolapsed Lumbar Disc

Kosteljanetz, Michael; Bang, Flemming; Schmidt-Olsen, Søren

doi:10.1097/00007632-198804000-00003

Cited by 79 publications

(24 citation statements)

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“…In order to improve agreement between the two reviewers, the aforementioned assessment tool was piloted using a few studies which have examined the diagnostic accuracy of Lasegue's test for diagnosing herniated discs of the low-back [6,29,33].…”

Section: Pilot Studymentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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Section: Pilot Studymentioning

confidence: 99%

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

et al. 2006

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“…The lack of standardized testing, a predominant design feature, negatively affects the test consistency and reliability. The reproducibility of the tests was poorly described, and only a single study investigated it in conjunction with the test accuracy [29].…”

Section: The Level Diagnosis Of a Lumbar Disc Herniationmentioning

confidence: 99%

Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review

Vroomen

Krom

Knottnerus

1999

Journal of Neurology

139

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We conducted a systematic review of the literature from 1965-1994 to assess the value of history and physical examination in the diagnosis of sciatica due to disc herniation; we also included population characteristics and features of the study design affecting diagnostic value. Studies on the diagnostic value of history and physical examination in the diagnosis of sciatica due to disc herniation are subject to important biases, and information on numerous signs and symptoms is scarce or absent. Our search revealed 37 studies meeting the selection criteria; these were systematically and independently read by three readers to determine diagnostic test properties using a standard scoring list to determine the methodological quality of the diagnostic information. A meta-analysis was performed when study results allowed statistical pooling. Few studies investigated the value of the history. Pain distribution seemed to be the only useful history item. Of the physical examination signs the straight leg raising test was the only sign consistently reported to be sensitive for sciatica due to disc herniation. However, the sensitivity values varied greatly, the pooled sensitivity and specificity values being 0.85 and 0.52, respectively. The crossed straight leg raising test was the only sign shown to be specific; the pooled sensitivity and specificity values were 0.30 and 0.84, respectively. There was considerable disagreement on the specificity of the other neurological signs (paresis, sensory loss, reflex loss). Several types of bias and other methodological drawbacks were encountered in the studies limiting the validity of the study results. As a result of these drawbacks it is probable that test sensitivity was overestimated and test specificity underestimated.

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“…In recent practice, the author tried to introduce MR imaging to resolve this problem, but in vain. As Las~gue's sign is a good indicator for a prolapsed disc [14], we recommend an exploration of the disc space during the instrumentation for patients with spinal instability showing a pre-existing positive Las~gue's sign. The patient in our series who required a subsequent discectomy had a positive Las~gue's sign pre-operatively.…”

Section: Discussionmentioning

confidence: 99%

Transpedicular reduction and stabilization for postlaminectomy lumbar instability

Lee

1996

Acta neurochir

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This study retrospectively reviewed the outcomes of 17 patients with postlaminectomy lumbar instability treated by transpedicular reduction and stabilization. The criteria of instability were defined strictly by both the clinical symptom of "instability catch" and the radiological findings that fulfilled Nachemson's criteria. Low back pain and/or sciatica that interfered largely with the patients' work or quality of life were the indications for this treatment. All the operations were performed by one surgeon with the same spinal instrumentation system-"AO internal fixator". The follow-up period was between 16 and 36 months (mean 24 months). Face to face questionnaire revealed that this treatment modality is encouraging. Fourteen patients (82%) had complete or nearly complete relief from all the pre-operative symptoms. Two (12%) had partial relief of the symptoms that required a subsequent discectomy or wider laminectomy. Only one case (6%) with osteoporosis remained unchanged after the operation. On the follow-up radiographs, sixteen patients (94%) showed good alignment and solid arthrodesis of the treated motion segment. These radiological findings correlated quite well with the absence of the clinical symptom of "instability catch". A common, but acceptable, complication found in this series was a variable degree of low back stiffness secondary to the instrumentation. Fracture of the screw was found in one patient and pull out of the screw was found in another patient. However, they did not elicit detectable symptoms. Osteoporosis, concomitant disc herniation and persistent spinal stenosis at/or adjacent to the operated level were the three main factors that may contribute to unsatisfactory results secondary to this treatment. These problems remain to be resolved in the future.

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The Clinical Significance of Straight-Leg Raising (Lasègueʼs Sign) in the Diagnosis of Prolapsed Lumbar Disc

Cited by 79 publications

References 0 publications

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review

Transpedicular reduction and stabilization for postlaminectomy lumbar instability

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