Accuracy of clinical tests in detecting disc herniation and nerve root compression in subjects with lumbar radicular symptoms

Publication date: Available online 15 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Harald Ekedahl, Bo Jönsson, Mårten Annertz, Richard B. Frobell
ObjectivesTo investigate the accuracy of three commonly used neurodynamic tests (Slump test, Straight leg raise test [SLR] and femoral neurodynamic test) and two clinical assessments to determine radiculopathy (I, one neurological sign; II, two neurological signs corresponding to one specific nerve root) in detecting MRI findings (extrusion, subarticular nerve root compression and foraminal nerve root compression).DesignValidity study.SettingSecondary care.ParticipantsWe included 99 subjects (mean age 58, 54% females), referred to epidural steroid injection due to lumbar radicular symptoms, with the following positive clinical findings: Slump test (n=67); SLR (n=50); femoral neurodynamic test (n=7); radiculopathy I (n=70) and radiculopathy II (n=33), and MRI findings: extrusion (n=27), subarticular nerve compression (SNC, n=14) and foraminal nerve compression (FNC, n=25).InterventionN/A.Main Outcome MeasureAccuracy of clinical tests in detecting MRI findings was evaluated using sensitivity, specificity and receiver operating characteristics (ROC) analysis with area under the curve (AUC).ResultsThe Slump test had the highest sensitivity in detecting extrusion (0.78) and SNC (1.00) but the respective specificity was low (0.36 and 0.38). Radiculopathy I was most sensitive in detecting FNC (0.80) but with low specificity (0.34). Only one assessment had a concurrent high sensitivity and specificity i.e. Radiculopathy II in detecting SNC (0.71 and 0.73, respectively). AUC for all tests in detecting extrusion, SNC and FNC ranged 0.48-0.60, 0.63-0.82 and 0.33-0.57, respectively.ConclusionGenerally, the investigated neurodynamic tests or assessments for radiculopathy lacked diagnostic accuracy. Slump test was the most sensitive test while Radiculopathy II was the most specific test. Most interestingly, no relationship was found between any neurodynamic test and FNC (foraminal stenosis) as visualized on MRI.



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