Validation study of a clinical diagnosis support tool for lumbar spinal stenosis

Kato, Yoshihiro; Kawakami, Toshifumi; Kifune, Masao; Kishimoto, Tetsuro; Nibu, Kimio; Oda, Hirotsugu; Shirasawa, Kenzo; Tominaga, Toshikatsu; Toyoda, Koichiro; Tsue, Kazunari; Taguchi, Toshihiko

doi:10.1007/s00776-009-1391-2

Cited by 9 publications

(13 citation statements)

References 14 publications

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“…This study by Kato et al 40 found that a positive result on the diagnostic support tool had an LR of 1.6 (95% CI, 1.3–2.0) and a negative result had an LR of 0.13 (95% CI, 0.04–0.41). Taken together, these data demonstrate that this diagnostic tool is most useful for ruling out the clinical syndrome of LSS but is of limited value for ruling in disease.…”

Section: Resultsmentioning

confidence: 87%

Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Suri¹,

Rainville²,

Kalichman³

et al. 2010

JAMA

181

174

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Section: Resultsmentioning

confidence: 87%

Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Suri¹,

Rainville²,

Kalichman³

et al. 2010

JAMA

181

174

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“…[83][84][85][86] A systematic review found that older age, pain with standing and walking, and relief with sitting or bending were common independent predictors of LSS across all prediction rules. 87 Only one of these prediction rules has been validated.…”

Section: Clinical Prediction Rulesmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

409

310

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Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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“…20 Another recent systematic review focusing on clinical prediction rules also found that older age, pain with standing/walking, and relief with sitting/bending were common independent predictors across all LSS prediction rules. 38–40,49 However, none of the previously cited studies employed an international consensus approach, and only one of these prediction rules has been validated. 38,49 This validated prediction rule has a positive likelihood ratio of just 1.6 (95% CI: 1.3 –2.0), suggesting that it may have limited application in increasing diagnostic likelihood.…”

Section: Discussionmentioning

confidence: 99%

“…38–40,49 However, none of the previously cited studies employed an international consensus approach, and only one of these prediction rules has been validated. 38,49 This validated prediction rule has a positive likelihood ratio of just 1.6 (95% CI: 1.3 –2.0), suggesting that it may have limited application in increasing diagnostic likelihood. 21 …”

Section: Discussionmentioning

confidence: 99%

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

Tomkins-Lane

Melloh

Lurie

et al. 2016

Spine

106

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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.

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Validation study of a clinical diagnosis support tool for lumbar spinal stenosis

Cited by 9 publications

References 14 publications

Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

Management of lumbar spinal stenosis

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

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