In this article, we will discuss lumbar disc herniation and physical examination
Lumbar disc herniation is one of the causes of back pain, but it is a moderately painful condition of lower extremity pain or sciatica due to pressure on the nerve roots.This is a condition that I have encountered so-so in my clinical practice, but even if you don't suspect this disease and treat back pain with complementary medicine or other methods, you can expect temporary relief, but not removal of the cause, so it will still hurt.In some cases, surgical treatment has a better outcome, so it is better to identify the syndrome as soon as possible.There are several types of physical tests that can be used to identify such a syndrome, and here is a review of their usefulness.
The studies
This is a rare review of 16 cohort studies and 3 case-control studies.
Of these, only one study was conducted in a primary care population.
Most of the physical tests (scoliosis, insufficiency paralysis or muscle weakness, muscle wasting, dysreflexia, and sensory deficits) yielded inadequate diagnostic performance.
Of these, a few tests (anterior flexion, hyperextension, and slump tests) performed slightly better, but the number of studies that validated them was small.
One primary care study showed high specificity and low sensitivity for most tests compared to other settings.
Most of the studies evaluated the straight leg raise (SLR) test.
In surgical populations characterized by a high prevalence of disc herniation (58-98%), the SLR test has a high sensitivity and varies widely in specificity.
Results from studies using imaging showed more heterogeneity and lower sensitivity.The crossed SLRs showed high specificity and consistently low sensitivity.
Combining positive test results increased the specificity of physical tests, but few studies presented data on combining tests.
Reviewer's conclusions
When used alone, the current evidence indicates that the diagnostic performance of most physical tests used to identify lumbar disc herniation is poor. However, most findings arise from surgical populations and may not be applicable to primary care or unselected populations. Combining the tests may improve performance.
van der Windt DAWM, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HCW, Aertgeerts B. Physical Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database of Systematic Reviews 2010 Cochrane Database of Systematic Reviews 2010, Issue 2, Art. No.: CD007431. DOI: 10.1002/14651858.CD007431.pub2.
Conclusion
This review confirmed the use of SLR testing and other physical testing methods, but the results suggest that the diagnostic performance of these tests is not high.Other tests for suspected neurogenesis have been reported to have a certain degree of sensitivity but insufficient specificity, so it is understandable that they do not have high performance in identifying lumbar disc herniation itself.Of course, there is also the skill level of the test itself, and practice is necessary to eliminate the possibility of false negatives due to lack of practice, but the performance of the test method itself needs to be understood.
Positive = Hernia! Positive = hernia, negative = no problem! Please try not to make shallow judgments such as "positive = hernia!
