DEGENERATIVE LUMBAR SPINAL STENOSIS - DIAGNOSTIC-VALUE OF THE HISTORYAND PHYSICAL-EXAMINATION

Objective, To assess the value of the history and physical examination findings in the diagnosis of symptomatic degenerative lumbar spinal s tenosis (LSS). Methods, The study was performed in 3 specialty clinics , and included patients with low back pain who were at least age 40, F indings from a standardized history and physical examination were comp ared with the diagnostic impression of expert attending clinicians, Im aging studies were available in 88% of those with LSS, and the finding s further supported the diagnosis of LSS in each case, The sensitivity , specificity, and likelihood ratio associated with each history and p hysical examination finding were calculated in bivariate analyses, and independent correlates of LSS were identified with multivariate analy ses. Results, Ninety-three patients were evaluated, History findings m ost strongly associated with the diagnosis of LSS (likelihood ratio gr eater than or equal to 2) were greater age, severe lower-extremity pai n, and absence of pain when seated, Physical examination findings most strongly associated with the diagnosis were wide-based gait, abnormal Romberg test result, thigh pain following 30 seconds of lumbar extens ion, and neuromuscular deficits, Independent correlates of LSS include d advanced age (P = 0.0001), absence of pain when seated (P = 0.006), wide-based gait (P = 0.013), and thigh pain following 30 seconds of lu mbar extension (P = 0.002). Conclusion, Specific history and physical examination findings are useful in the diagnosis of LSS and should be ascertained routinely in older patients with low back pain.