Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 72; no. 5; pp. 630 - 634
• Main Authors: Vroomen, P C A J, de Krom, M C T F M, Wilmink, J T, Kester, A D M, Knottnerus, J A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.05.2002; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Comorbidity; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Cross-Sectional Studies; Diagnosis; Diagnosis, Differential; Entrapment neuropathies; Evaluation; Female; Gold; Humans; Lumbosacral region; Magnetic Resonance Imaging; Male; Medical History Taking; Medical sciences; Middle Aged; nerve root compression; Nervous system (semeiology, syndromes); Neurologic Examination; Neurology; Periodic health examinations; Physical diagnosis; Physical Examination; Physiological aspects; Predictive Value of Tests; Radiculopathy - complications; Radiculopathy - diagnosis; Radiculopathy - pathology; Sciatica; Sciatica - etiology; Sensitivity and Specificity; Netherlands; Nervous system diseases; Compression; Nuclear magnetic resonance imaging; Spinal root; Pain; Predictive value; Medical imagery; Clinical investigation; Peripheral nerve disease; Diagnosis; Lumbosacral; Antecedent; Sciatica
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.72.5.630

Objective: To evaluate patient characteristics, symptoms, and examination findings in the clinical diagnosis of lumbosacral nerve root compression causing sciatica. Methods: The study involved 274 patients with pain radiating into the leg. All had a standardised clinical assessment and magnetic resonance (MR) imaging. The associations between patient characteristics, clinical findings, and lumbosacral nerve root compression on MR imaging were analysed. Results: Nerve root compression was associated with three patient characteristics, three symptoms, and four physical examination findings (paresis, absence of tendon reflexes, a positive straight leg raising test, and increased finger-floor distance). Multivariate analysis, analysing the independent diagnostic value of the tests, showed that nerve root compression was predicted by two patient characteristics, four symptoms, and two signs (increased finger-floor distance and paresis). The straight leg raise test was not predictive. The area under the curve of the receiver-operating characteristic was 0.80 for the history items. It increased to 0.83 when the physical examination items were added. Conclusions: Various clinical findings were found to be associated with nerve root compression on MR imaging. While this set of findings agrees well with those commonly used in daily practice, the tests tended to have lower sensitivity and specificity than previously reported. Stepwise multivariate analysis showed that most of the diagnostic information revealed by physical examination findings had already been revealed by the history items.