Lumbar Dx Clusters

Question 1

Diagnostic Cluster for Lumbar Stenosis:

Answer 1

► Relief during immediate sitting is strongly suggestive of spinal stenosis (Sensitivity 0.46; Specificity 0.93).
The most diagnostic combination included a cluster of:
1) bilateral symptoms;
2) leg pain more than back pain;
3) pain during walking/standing;
4) pain relief upon sitting;
age >48 years

Question 2

Diagnostic Cluster for Cauda Equina Syndrome:

Answer 2

· Rapid symptoms within 24 hours 89% sensitivity
· History of back pain 94% sensitivity
· Urinary retention 90% sensitivity
· Loss of sphincter tone 80% sensitivity
· Sacral sensation loss 85% sensitivity
Lower extremity weakness or gait loss 84%sensitivity

Question 3

Diagnostic Cluster for Lumbar Radiculopathy:

Answer 3

· Dermatomal pattern (OR = 4.1)
	· Pain on cough, sneezing, straining (OR = 3.2)
	· More pain Sitting (OR=1.9)
	· Subjective muscle weakness (OR = 2.2)
	· Subjective Sensory loss (OR = 2.1)
	· Paresis/Motor Loss (OR = 3.7)
	· +SLR (OR = 3.9)
	· Unilat Ankle reflex (OR = 3.9) ... 0 is DTR for achilles reflex

Question 4

Diagnostic Cluster for Lumbar Compression fracture:

Answer 4

· age >50 (sensitivity 0.84, specificity 0.61)
· age >70 (sensitivity 0.22, specificity 0.96)
· trauma (sensitivity 0.30, specificity 0.85)
· Adequate trauma, although in elderly trauma can be minor
corticosteroid use (sensitivity 0.06, specificity 0.995)

Question 5

Diagnostic Cluster for Spine Cancer:

Answer 5

· Age > 50 (sensitivity 0.77, specificity 0.71)
· previous history of cancer (sensitivity 0.31, specificity 0.98)
· failure to improve in 1 mo. of therapy (sensitivity 0.31, specificity 0.90)
· no relief with bed rest (sensitivity >0.90, specificity 0.46)
· duration of pain > 1 mo (sensitivity 0.50, specificity 0.81)
· COMBO: age >50 or cancer hx or unexplained wt loss or failure of conservative tx (sensitivity 1.00, specificity 0.60)
· Insidious onset (no stats)
constitutional symptoms (no stats)

Question 6

Diagnostic Cluster Ankylosing Spondylitis:

Answer 6

· age at onset <40 (sensitivity 1.00, specificity 0.07)
· pain not relieved by supine position (sensitivity 0.80, specificity 0.49)
· morning back stiffness 0.64 0.59
· pain duration >3 months 0.71 0.54
4 of 5 questions above positive also: improved by exercise 0.23 0.82 +LR = 1.27