The reliability of LERI’s sign in L4 and L3 radiculalgia

Abstract

Although not as frequent as sciatica, cruralgia remains one of the most frequent reasons why people consult a neurosurgeon. It should be kept in mind, however, that every anterior leg pain is not cruralgia and thus several diagnoses must be discarded, such as of musculoskeletal diseases of hip, pelvis and femur. In the last years of the 19th century, André Léri, a French neurologist, described Leri's sign as it is used widely even today in everyday clinical practice. We studied retrospectively files of those patients who were seen in Neurosurgery by the authors for L3 and L4 nerve root compression to evaluate the reliability and accuracy of this sign. Between October 1998 and September 2017, 38,654 patients were examined in our department of Neurosurgery. Among them, 1698 patients presented pain as cruralgia and meralgia. In total, 1545 patients were included in the study. The data analysis showed that the sensitivity of LS was 0.9333 and the specificity 0.7974. The results of the study show a reliable diagnostic accuracy of Leri's sign.

André Léri (1875–1930 AD) and his legacy to neuroscience

“…Léri's sign, an equivalent of Lasègue's sign or the straight leg raise, is also known as the Binverted Laseque sign^and among neurologists and neurosurgeons; it is known as the Bfemoral nerve stretch test^or the Bprone knee bending test^ [1,4,5]. This test is used to irritate the L3 and L4 nerve roots.…”

“…Léri's sign is used for testing of the roots of the femoral nerve ( Fig. 1 and cover) [5]. Anatomically, it is known that the L3 nerve root provides sensation to the medial surface of the thigh and the side of the knee, while the L4 nerve root provides sensation to the front of the thigh and leg and foot.…”

“…In 1910, Léri was appointed as associate professor at the University of Paris, Faculty of Medicine [1]. Between 1914 and 1918, he led medical military hospitals [1] and wrote on such diseases as tabes dorsalis in syphilis and lipomata [4,5]. He documented mental disorders, such as hysteria, psychosis, nevrosis, psychonevrosis, and neurasthenia [1].…”

Demographic predictors of treatments and surgical complications of lumbar degenerative diseases

“…Roughly 90% of lumbar disk herniations and nerve compressions occur between L4-L5 and L5-S1, which may result in radiculopathy in the areas of corresponding dermatomes in the lower limbs. [4,5] Although age-related degenerative diseases of the lumbar spine are well documented in the literature, [6][7][8] demographic predictors of poor patient outcomes, including race, insurance type, sex, and hospital status, have yet to be thoroughly evaluated. This study utilizes 5 years of a national United States administrative hospital database to query all patients diagnosed with lumbar degenerative disease, their relevant demographics, and their inpatient complication and management profiles.…”

Outcome of transpedicular screw fixation with posterior interbody fusion in management of Spondylolysthesis.

“…Spondylolysthesis affects 2.7%-5.0% of adult males and 8.1%-10.0% of adult females, and about 5% with L5-S1 as the commonest affected level in pediatrics [2] . There were five grades of slippage expressed as a percentage of the width of the slipped vertebral body (0-25%, 25-50%, 50-75%, 75-100% and more than 100.0% for grades I, II, III, IV and V successively) [3] .…”