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Chances of accurate lumbar spinal stenosis diagnosis increase when key questions are asked
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SAN FRANCISCO — An International Delphi Study conducted by The International Taskforce on Diagnosis and Management of Lumbar Spinal Stenosis recently identified key questions to ask when getting a patient’s history that may help clinicians more accurately diagnose lumbar spinal stenosis.
“This study showed that with just six questions, clinicians become 80% certain that the person has clinical diagnosis of lumbar spinal stenosis (LSS),” Christy C. Tomkins-Lane, PhD, said in a presentation at the International Society for the Study of the Lumbar Spine Annual Meeting, here. “This is a pragmatic question set that can be used in a number of settings — research settings, teaching [and] potentially in the clinical setting — and provides standardized criteria.”
The task force initially agreed upon a list of 14 clinical questions deemed important in the diagnosis of LSS and understanding a patient’s history, based on the input of physicians with at least 20 years’ experience with LSS. An online recursive study was performed to narrow down the possible items to those that were most clinically relevant, and then the items were tested.
Christy C. Tomkins-Lane
Tomkins-Lane said the most common items ultimately identified were leg or buttocks pain while walking, flexing forward while walking to relieve symptoms, sitting down or bending forward to relieve pain, normal foot pulses, relief with rest and lower extremity weakness.
“We then held a final consensus meeting yesterday of the task force and confirmed this final set of six items, with the additional item of ‘Does the patient have low back pain?’” Tomkins-Lane said.
“This study did not account for physical examination or other diagnostic tests. So, our plan is to continue this study to account for those other aspects of diagnosis,” she said.
During testing of the final six questions, the task force detected changes in a clinician’s certainty ceased when those particular questions were asked, with clinician certainty remaining steady at 81%, according to the researchers. – by Susan M. Rapp
Reference:
Tomkins-Lane CC, et al. Paper #13. Presented at: International Society for the Study of the Lumbar Spine Annual Meeting; June 8-12, 2015; San Francisco.
Disclosure: Tomkins-Lane reports no relevant financial disclosures.