Intervertebral disc |
Studies supporting a diagnostic rule |
Centralization (P) Donelson 1997 [31] | 0.64 (0.46–0.79) | 0.70 (0.50–0.86) | 2.1 (1.2–3.9) | 0.52 (0.32–0.86) |
Centralization (P)a Young 2003
[32]
| 0.47 (0.22–0.73) | 0.95 (0.62–1.0) | 9.4 (0.6–146.9) | 0.56 (0.35–0.91) |
Centralization (P)a Laslett 2005
[33]
| 0.40 (0.28–0.54) | 0.94 (0.73–0.99) | 6.9 (1.0–47.3) | 0.63 (0.49–0.82) |
Studies not supporting a diagnostic rule |
None | | | | |
Additional findings reported by more than one study |
Pain crosses midlinea (H) Young 2003 [32] | 0.27 (0.11–0.52) | 0.38 (0.14–0.69) | 0.4 (0.2–1.2) | 1.96 (0.76–5.03) |
Midline pain only (H) Schwarzer 1995
[34]
| 0.03 (0.00–0.14) | --- | --- | --- |
Facet joint |
Revel’s suggested rule: 5 of 7 positive findings Manchikanti 2000
[35]
| 0.13 (0.07–0.22) | 0.84 (0.76–0.90) | 0.8 (0.4–1.7) | 1.03 (0.92–1.16) |
Age more than 65 years (H) | 0.22 (0.14–0.32) | 0.85 (0.77–0.91) | 1.5 (0.8–2.6) | 0.92 (0.80–1.05) |
Pain relieved in recumbent position (P) | 0.94 (0.86–0.98) | 0.17 (0.10–0.25) | 1.1 (1.0–1.2) | 0.39 (0.18–0.96) |
Pain not increased with cough (P) | 0.90 (0.82–0.95) | 0.13 (0.08–0.21) | 1.0 (0.9–1.1) | 0.76 (0.34–1.66) |
Pain not increased with forward flexion (P) | 0.16 (0.09–0.25) | 0.82 (0.73–0.88) | 0.9 (0.5–1.6) | 1.03 (0.91–1.17) |
Pain not increased with rising from flexion (P) | 0.55 (0.44–0.65) | 0.48 (0.39–0.58) | 1.1 (0.8–1.4) | 0.94 (0.70–1.26) |
Pain not increased with hyperextension (P) | 0.10 (0.05–0.18) | 0.86 (0.78–0.92) | 0.7 (0.3–1.2) | 1.05 (0.95–1.16) |
Pain not increased with extension/rotation (P) | 0.68 (0.57–0.77) | 0.30 (0.22–0.40) | 1.0 (0.8–1.2) | 1.07 (0.71–1.61) |
Studies supporting items of Revel’s suggested rule |
Pain relieved in recumbent position (P) Single block Revel 1998
[38]
| 0.96 (0.71–1.00) | 0.48 (0.30–0.67) | 1.9 (1.3–2.7) | 0.07 (0.01–1.15) |
Pain relieved in recumbent position (P) Single block Revel 1992
[37]
| 0.63 (0.41–0.82) | 0.76 (0.52–0.92) | 2.7 (1.1–6.3) | 0.48 (0.27–0.87) |
Studies not supporting items of Revel’s suggested rule |
Age more than 65 years (H) Manchikanti 1999
[36]
| 0.19 (0.10–0.32) | 0.66 (0.54–0.78) | 0.6 (0.3–1.1) | 1.21 (0.98–1.51) |
Age more than 61 years (H) Manchikanti 2008
[41]
| 0.19 (0.12–0.29) | 0.75 (0.69–0.81) | 0.8 (0.5–1.3) | 1.07 (0.94–1.12) |
No pain with extension/rotation (P) Schwarzer 1994
[42]
| 0.0 (0.0–0.13) | 0.88 (0.82–0.93) | 0.0 (---) | 1.13 (1.07–1.20) |
No pain with hyperextension (P) Fairbank 1981
[43]
| 0.36 (0.16–0.61) | 0.36 (0.15–0.65) | 0.6 (0.2–1.3) | 1.77 (0.74–4.24) |
Revel’s suggested rule Single blocka Laslett 2004
[40]
| 0.11 (0.39–2.8) | 0.91 (0.83–0.95) | 1.2 (0.4–4.3) | 0.98 0.84–1.13 |
Additional findings reported by more than one study |
Traumatic onset (H) Manchikanti 2000 [35] | 0.48 (0.37–0.59) | 0.50 (0.41–0.59) | 1.0 (0.7–1.3) | 1.05 (0.80–1.37) |
Traumatic onset (H) Manchikanti 1999 [36] | 0.54 (0.40–0.67) | 0.47 (0.35–0.60) | 1.0 (0.7–1.4) | 0.99 (0.67–1.44) |
No centralization (P) Single blocka Young 2003 [32] | 1.00 (0.78–1.0) | 0.11 (0.02–0.44) | 1.3 (0.9–1.4) | NA |
No centralization (P) Single blocka Laslett 2006
[39]
| 1.00 (0.74–1.0) | 0.17 (0.11–0.27) | 1.2 (1.1–1.3) | NA |
Sacroiliac joint |
Laslett composite: no centralization and 3 of 5 positive findings: distraction, compression, thigh thrust, Gaenslen’s test, sacral thrust (P)a Laslett 2003
[44]
| 0.91 (0.62–0.98) | 0.87 (0.68–0.95) | 7.0 (2.4–20.4) | 0.11 (0.02–0.68) |
Laslett rule: 3 of 5 positive findings alone (P)a Laslett 2003 [44] | 0.91 (0.62–0.98) | 0.78 (0.61–0.89) | 4.2 (2.1–8.2) | 0.12 (0.02–0.76) |
Studies supporting items of Laslett’s rule |
van der Wurff composite 3 out of 5 positive findings: distraction, compression, thigh thrust, Gaenslen’s test, Patrick’s test (P) van der Wurff 2006
[45]
| 0.85 (0.72–0.99) | 0.79 (0.65–0.93) | 4.0 (2.0–7.9) | 0.19 (0.07–0.47) |
Stanford composite 3 out of 5 positive findings: Patrick’s test, thigh thrust, Gaenslen’s test, compression, sacral thrust (P) Stanford 2010
[47]
| 0.82 (0.52–0.95) | 0.57 (0.37–0.74) | 1.9 (1.1–3.2) | 0.32 (0.09–1.19) |
Ozgocmen composite 3 out of 5 positive findings: Patrick’s test, thigh thrust, Gaenslen’s test, Mennell, sacral thrust (P) Ozgocmen 2008
[48]
| 0.45 (0.18–0.75) | 0.89 (0.71–0.97) | 4.4 (1.3–15.4) | 0.62 (---) |
No centralization (P) Single blocka Young 2003 [32] | 0.92 (0.76–0.98) | 0.23 (0.12–0.41) | 1.2 (1.0–1.5) | 0.33 (0.08–1.45) |
Studies not supporting items of Laslett’s rule |
Gaenslen’s test (P) Single block Dreyfuss 1996
[46]
| 0.67 (0.52–0.79) | 0.35 (0.22–0.50) | 1.0 (0.8–1.4) | 0.95 (0.53–1.72) |
Thigh thrust (P) Single block Dreyfuss 1996 [46] | 0.42 (0.29–0.57) | 0.45 (0.31–0.60) | 0.8 (0.5–1.2) | 1.28 (0.84–1.96) |
Sacral thrust (P) Single block Dreyfuss 1996 [46] | 0.51 (0.36–0.66) | 0.40 (0.25–0.57) | 0.9 (0.6–1.2) | 1.22 (0.76–1.96) |
Additional findings reported by more than one study |
Dominant pain in SIJ without tuber area (H) Van der Wurff 2006 [49] | 0.89 (0.72–0.96) | 0.79 (0.62–0.89) | 4.2 (2.1–8.20) | 0.14 (0.05–0.42) |
PSIS pointing Single block Dreyfuss 1996 [46] | 0.71 (0.57–0.82) | 0.48 (0.33–0.63) | 1.4 (1.0–1.9) | 0.61 (0.35–1.07) |
Disc herniation with nerve root involvement |
Hancock rule L4 nerve, 3 out of 4 positive findings: corresponding dermatomal pain location, sensory deficits, reflex and motor weakness Hancock 2011
[52]
| 0.50 (0.21–0.79) | 0.90 (0.85–0.93) | 5.0 (?) | 0.01 (?) |
Hancock rule L5 nerve, 3 out of 4 positive findings: Corresponding dermatomal pain location, sensory deficits, reflex and motor weakness Hancock 2011 [52] | 0.37 (0.28–0.46) | 0.83 (0.76–0.88) | 2.2 (?) | 0.76 (?) |
Hancock rule S1 nerve, 3 out of 4 positive findings: corresponding dermatomal pain location, sensory deficits, reflex and motor weakness Hancock 2011 [52] | 0.28 (0.21–0.35) | 0.94 (0.88–0.98) | 4.7 (?) | 0.77 (?) |
L4 dermatomal pain location only (P) L3 disc | 0.39 (0.14–0.68) | 0.97 (0.94–0.99) | 13.0 (?) | 0.63 (?) |
L5 pain dermatomal location only (P) L4 disc | 0.25 (0.18–0.34) | 0.92 (0.86–0.96) | 3.2 (?) | 0.79 (?) |
S1 pain dermatomal location only (P) L5 disc | 0.22 (0.16–0.29) | 0.98 (0.94–1.00) | 11.0 (?) | 0.80 (?) |
L4 location sensory loss (P) L3 disc | 0.42 (0.15–0.72) | 0.74 (0.69–0.79) | 1.6 (0.8–3.3) | 0.79 (0.49–1.28) |
L5 location sensory loss (P) L4 disc | 0.60 (0.51–0.69) | 0.54 (0.45–0.62) | 1.3 (1.0–1.6) | 0.75 (0.58–0.97) |
S1 location sensory loss (P) L5 disc | 0.59 (0.51–0.66) | 0.60 (0.50–0.69) | 1.5 (1.1–1.9) | 0.69 (0.54–0.87) |
Patellar reflex weakness (P) L3 disc | 0.50 (0.21–0.79) | 0. 83 (0.78–0.87) | 2.9 (0.6–5.5) | 0.60 (0.34–1.06) |
Achilles reflex weakness (P) L5 disc | 0.48 (0.40–0.56) | 0.83 (0.75–0.90) | 2.9 (1.8–4.5) | 0.62 (0.52–0.74) |
Quadriceps weakness (P) L3 disc | 0.67 (0.35–0.90) | 0.40 (0.34–0.46) | 1.1 (0.7–1.7) | 0.84 (0.37–1.89) |
Tibialis anterior weakness (P) L4 disc | 0.46 (0.37–0.55) | 0.70 (0.63–0.77) | 1.6 (1.1–2.1) | 0.77 (0.63–0.93) |
Peroneal weakness (P) L4 disc | 0.50 (0.41–0.59) | 0.68 (0.60–0.75) | 1.6 (1.2–2.1) | 0.73 (0.60–0.90) |
Ext. hallucis longus weakness (P) L4 disc | 0.54 (0.44–0.63) | 0.64 (0.56–0.72) | 1.5 (1.2–2.0) | 0.72 (0.58–0.90) |
Calf weakness (P) L5 disc | 0.30 (0.23–0.38) | 0.63 (0.53–0.72) | 0.8 (0.6–1.1) | 1.11 (0.94–1.33) |
Studies supporting items of the Hancock rule |
All 3 findings positive: sensory loss, paresis, loss of reflexes (P) any nerve Vroomen 1998
[74]
| 0.31 (0.14–0.56) | 0.93 (0.83–0.97) | 4.3 (1.3–14.1) | 0.74 (0.53–1.04) |
Dermatomal pain location (H) any nerve Vroomen 2002
[53]
| 0.89 (0.84–0.93) | 0.31 (0.24–0.40) | 1.3 (1.1–1.5) | 0.34 (0.20–0.58) |
Pain location (H) corresponding S1 nerve Bertilson 2010
[54]
| 0.55 (0.28–0.79) | 0.76 (0.63–0.86) | 2.3 (1.1–4.7) | 0.60 (0.31–1.16) |
L5 location sensory loss (P) disc L4 Kerr 1988 [55] | 0.30 (0.19–0.44) | 0.86 (0.71–0.94) | 2.2 (0.9–5.4) | 0.81 (0.65–1.02) |
S1 location sensory loss (P) disc L5 Kerr 1988 [55] | 0.45 (0.31–0.59) | 0.86 (0.71–0.94) | 3.2 (1.3–7.7) | 0.64 (0.48–0.86) |
Anterior thigh sensory loss (P) L2-L4 nerves Suri 2010 [56] | 0.08 (1.01–0.27) | 0.96 (0.82–1.00) | 2.3 (0.23–24.2) | 0.95 (0.83–1.09) |
Anterior thigh sensory loss (P) L2 nerve Suri 2010 [56] | 0.50 (0.01–0.99) | 0.96 (0.86–1.00) | 12.5 (1.8–87.0) | 0.52 (0.13–2.08) |
Medial knee sensory loss (P) L2-L4 nerves Suri 2010 [56] | 0.17 (0.05–0.37) | 0.96 (0.82–1.00) | 4.7 (0.6–39.00) | 0.86 (0.71–1.05) |
Medial ankle sensory loss (P) L2-L4 nerves Suri 2010 [56] | 0.17 (0.05–0.37) | 1.00 (0.88–1.00) | NA | 0.83 (0.69–1.01) |
Medial ankle sensory loss (P) L4 nerve Suri 2010 [56] | 0.31 (0.09–0.61) | 1.00 (0.91–1.00) | NA | 0.69 (0.48–0.99) |
Medial foot sensory loss (P) L4 disc Gurdjian 1961 [57] | 0.13 (0.11–0.16) | 0.94 (0.92–0.96) | 2.3 (1.5–3.3) | 0.92 (0.89–0.96) |
Lateral foot sensory loss (P) L5-S1 nerves Suri 2010 [56] | 0.21 (0.08–0.41) | 0.92 (0.73–0.99) | 2.6 (0.6–11.6) | 0.86 (0.68–1.08) |
Lateral foot sensory loss(P) L5 disc Gurdjian 1961 [57] | 0.23 (0.20–0.27) | 0.90 (0.87–0.92) | 2.3 (1.7–3.1) | 0.85 (0.81–0.90) |
S1 location sensory loss (P) L5 disc Kerr 1988
[49]
| 0.47 (0.33–0.61) | 0.86 (0.71–0.94) | 3.3 (1.4–8.0) | 0.61 (0.46–0.83) |
Patellar reflex weakness (P) L4 nerve Suri 2010 [56] | 0.39 (0.18–0.65) | 0.95 (0.84–0.99) | 7.7 (1.7–35.0) | 0.65 (0.42–1.00) |
Patellar reflex weakness (P) L3 disc Knutsson 1961
[58]
| 1.00 (0.34–1.00) | 0.84 (0.78–0.89) | 6.4 (4.6–9.0) | NA |
Achilles reflex weakness (P) L5-S1 nerves Suri 2010 [56] | 0.29 (0.13–0.49) | 0.96 (0.80–1.00) | 7.1 (1.0–53.2) | 0.74 (0.58–0.95) |
Achilles reflex weakness (P) L5 nerve Suri 2010 [56] | 0.33 (0.16–0.56) | 0.91 (0.78–0.97) | 3.9 (1.1–13.8) | 0.73 (0.52–1.03) |
Achilles reflex weakness (P) L5 disc Gurdjian 1961
[57]
| 0.56 (0.52–0.60) | 0.75 (0.71–0.79) | 2.3 (1.9–2.7) | 0.58 (0.52–0.64) |
Achilles reflex weakness (P) L5 disc Kerr 1988 [55] | 0.87 (0.75–0.94) | 0.89 (0.75–0.96) | 7.9 (3.1–19.9) | 0.14 (0.07–0.31) |
Achilles reflex weakness (P) L5 disc Knutsson 1961 [58] | 0.78 (0.67–0.86) | 0.65 (0.55–0.73) | 2.2 (1.7–2.9) | 0.34 (0.22–0.54) |
Reflex absence ankle/knee (P) any nerve Vroomen 2002 [53] | 0.14 (0.09–0.21) | 0.93 (0.88–0.97) | 2.2 (1.0–4.8) | 0.91 (0.84–0.99) |
Sit to stand weakness (P) L3 nerve Suri 2010
[56]
| 0.50 (0.19–0.81) | 0.77 (0.62–0.89) | 2.2 (1.00–5.0) | 0.65 (0.34–1.23) |
Sit to stand weakness (P) L4 nerve Suri 2010 [56] | 0.54 (0.25–0.81) | 0.80 (0.65–0.91) | 2.8 (1.2–6.1) | 0.57 (0.31–1.05) |
Heel raise weakness (P) L5-S1 nerves Suri 2010 [56] | 0.14 (0.04–0.32) | 0.96 (0.80–1.00) | 3.5 (0.4–28.9) | 0.90 (0.76–1.06) |
Great toe ext. weakness (P) L5 nerve Suri 2010 [56] | 0.61 (0.36–0.83) | 0.86 (0.71–0.95) | 4.4 (1.8–10.8) | 0.45 (0.25–0.82) |
Great toe ext. weakness (P) L4 disc Knutsson 1961 [58] | 0.75 (0.65–0.83) | 0.53 (0.43–0.63) | 1.6 (1.3–2.1) | 0.47 (0.31–0.71) |
Ankle dorsiflexion weakness (P) L4 disc Kerr 1988 [55] | 0.60 (0.46–0.72) | 0.89 (0.75–0.96) | 5.4 (2.1–13.9) | 0.45 (0.31–0.64) |
Ankle plantarflexion weakness (P) L5 disc Kerr 1988 [55] | 0.13 (0.06–0.25) | 1.00 (0.90–1.00) | NA | 0.87 (0.78–0.97) |
Paresis not specified (P) any nerve Vroomen 2002 [53] | 0.27 (0.21–0.35) | 0.93 (0.88–0.97) | 4.1 (2.0–8.4) | 0.78 (0.70–0.87) |
Studies not supporting items of the Hancock rule |
Pain location (H) corresponding L4 nerve Bertilson 2010 [54] | 0.00 (0.00–0.32) | 0.85 (0.73–0.92) | 0.0 (NA) | 1.18 (1.05–1.32) |
Pain location (H) corresponding L5 nerve Bertilson 2010 [54] | 0.78 (0.55–0.91) | 0.28 (0.17–0.43) | 1.1 (0.79–1.47) | 0.80 (0.30–2.14) |
Non-specific sensory deficits (P) any disc level Stankovic 1999 [59] | 0.56 (0.42–0.68) | 0.40 (0.28–0.53) | 0.9 (0.7–1.3) | 1.12 (0.71–1.75) |
Non-specific sensory deficits (P) any disc level Vucetic 1996
[60]
| 0.45 (0.37–0.53) | 0.69 (0.39–0.91) | 1.5 (0.6–3.3) | 0.80 (0.54–1.18) |
Sensory loss not specified (P) L3-L5 discs Kosteljanetz 1984 [63] | 0.60 (0.47–0.73) | 0.57 (0.41–0.72) | 1.4 (0.9–2.1) | 0.69 (0.46–1.05) |
Sensory loss not specified (P) L3-L5 disc Knutsson 1961 [58] | 0.28 (0.22–0.36) | 0.65 (0.41–0.85) | 0.8 (0.4–1.6) | 1.10 (0.79–1.54) |
Sensory loss not specified (P) L5 or S1 nerve Albeck 1996
[61]
| 0.67 (0.54–0.79) | 0.42 (0.20–0.67) | 1.2 (0.8–1.8) | 0.78 (0.41–1.47) |
Great toe sensory loss (P) L5-S1 nerves Suri 2010 [56] | 0.18 (0.06–0.37) | 0.87 (0.66–0.97) | 1.4 (0.4–5.1) | 0.94 (0.75–1.19) |
Hypesthesia (P) any nerve Vroomen 2002 [53] | 0.28 (0.21–0.36) | 0.66 (0.56–0.74) | 0.8 (0.6–1.2) | 1.09 (0.93–1.29) |
Hypalgesia (P) any nerve Vroomen 2002 [53] | 0.17 (0.11–0.24) | 0.84 (0.77–0.90) | 1.1 (0.6–1.9) | 0.98 (0.88–1.09) |
Hypesthesia (P) L5 or S1 nerve (P) Albeck 1996 [61] | 0.67 (0.54–0.79) | 0.42 (0.20–0.67) | 1.2 (0.8–1.8) | 0.78 (0.41–1.47) |
Disturbed touch sensibility (P) corresponding L4 nerve Bertilson 2010 [54] | 0.13 (0.02–0.47) | 0.75 (0.62–0.85) | 0.5 (0.1–3.4) | 1.16 (0.86–1.57) |
Disturbed touch (P) corresponding L5 nerve Bertilson 2010 [54] | 0.22 (0.09–0.45) | 0.51 (0.37–0.65) | 0.5 (0.2–1.1) | 1.52 (1.04–2.23) |
Disturbed touch sensibility (P) corresponding S1 nerve Bertilson 2010 [54] | 0.36 (0.15–0.65) | 0.68 (0.54–0.79) | 1.1 (0.5–2.7) | 0.94 (0.58–1.52) |
Disturbed pain sensibility (P) corresponding L4nerve Bertilson 2010 [54] | 0.00 (0.00–0.32) | 0.45 (034.–0.60) | 0.0 (NA) | 2.1 (1.59.–2.82) |
Disturbed pain sensibility (P) corresponding L5 nerve Bertilson 2010 [54] | 0.44 (0.25–0.66) | 0.40 (0.26–0.54) | 0.7 (0.4–1.3) | 1.4 (0.81.–2.45) |
Disturbed pain sensibility (P) corresponding S1 nerve Bertilson 2010 [54] | 0.36 (0.15–0.65) | 0.58 (0.44–0.71) | 0.9 (0.4–2.0) | 1.10 (0.66.–1.81) |
Patellar reflex weakness (P) L3 disc Gurdjian 1961 [57] | 0.02 (0.00–0.12) | 0.92 (0.91–0.94) | 0.3 (0.0–2.2) | 1.06 (1.01–1.11) |
Achilles reflex weakness (P) L3-L5 disc Spangfort 1972 [62] | 0.31 (0.29–0.33) | 0.80 (0.76–0.84) | 1.6 (1.3–2.0) | 0.86 (0.81–0.91) |
Reflex weakness not specified (P) L5 or S1 nerve Albeck 1996 [61] | 0.61 (0.47–0.73) | 0.63 (0.38–0.84) | 1.7 (0.9–3.1) | 0.62 (0.39–0.99) |
Disturbed reflexes not specified (P) corresponding L4 nerve Bertilson 2010 [54] | 0.38 (0.14–0.69) | 0.64 (0.51–0.76) | 1.0 (0.4–2.7) | 1.00 (0.55–1.73) |
Disturbed reflexes not specified (P) corresponding L5 nerve Bertilson 2010 [54] | 0.61 (0.39–0.80) | 0.56 (0.41–0.70) | 1.4 (0.8–2.3) | 0.70 (0.37–1.32) |
Disturbed reflexes not specified (P) corresponding S1 nerve Bertilson 2010 [54] | 0.27 (0.10–0.57) | 0.48 (0.35–0.62) | 0.5 (0.2–1.4) | 1.52 (0.95–2.41) |
Reflex weakness not specified (P) any disc level Stankovic 1999 [59] | 0.46 (0.33–0.60) | 0.70 (0.56–0.80) | 1.5 (0.9–2.5) | 0.77 (0.57–1.05) |
Reflex weakness not specified (P) any level Vucetic 1996 [60] | 0.35 (0.28–0.44) | 0.77 (0.46–0.95) | 1.5 (0.6–4.2) | 0.84 (0.61–1.16) |
Heel walk weakness (P) L5-S1 nerves Suri 2010 [56] | 0.14 (0.04–0.32) | 0.80 (0.59–0.93) | 0.7 (0.2–2.3) | 1.08 (0.84–1.38) |
Great toe ext. weakness (P) L5-S1 nerves Suri 2010 [56] | 0.38 (0.21–0.58) | 0.80 (0.59–0.93) | 1.9 (0.8–4.7) | 0.78 (0.55–1.10) |
Ankle dorsiflexion weakness (P) any level Vucetic 1996 [60] | 0.29 (0.22–0.37) | 0.77 (0.46–0.95) | 1.2 (0.4–3.5) | 0.93 (0.68–1.27) |
Foot drop (P) L4 disc Gurdjian 1961
[51]
| 0.01 (0.00–0.01) | 0.93 (0.86–0.97) | 0.1 (0.0–0.3) | 1.07 (1.01–1.13) |
Extensor hallucis longus weakness (P) L4 disc Gurdjian 1961 [57] | 0.20 (0.17–0.23) | 0.88 (0.86–0.91) | 1.8 (1.3–2.3) | 0.90 (0.86–0.95) |
Ankle dorsiflex weakness (P) L3-L5 disc Spangfort 1972 [62] | 0.30 (0.28–0.32) | 0.66 (0.61–0.71) | 0.9 (0.8–1.1) | 1.06 (0.97–1.15) |
Disturbed motor function not specified (P) corresponding L4 nerve Bertilson 2010 [54] | 0.50 (0.22–0.78) | 0.53 (0.40–0.66) | 1.1 (0.5–2.2) | 0.95 (0.45–1.98) |
Disturbed motor function not specified (P) corresponding L5 nerve Bertilson 2010 [54] | 0.56 (0.34–0.75) | 0.42 (0.28–0.57) | 1.0 (0.6–1.6) | 1.06 (0.57–1.98) |
Disturbed motor function not specified (P) corresponding S1nerve Bertilson 2010 [54] | 0.36 (0.15–0.65) | 0.62 (0.48–0.74) | 1.0 (0.4–2.3) | 1.03 (0.63–1.69) |
Motor weakness not specified (P) L5 or S1 nerve Albeck 1996 [61] | 0.34 (0.23–0.48) | 0.47 (0.24–0.71) | 0.7 (0.4–1.1) | 1.38 (0.83–2.30) |
Motor weakness not specified (P) L3-L5 disc Knutsson 1961 [58] | 0.62 (0.54–0.69) | 0.50 (0.27–0.73) | 1.2 (0.8–2.0) | 0.77 (0.70–1.49) |
Motor weakness not specified (P) L3-L5 discs Kosteljanetz 1984
[63]
| 0.47 (0.33–0.60) | 0.52 (0.36–0.68) | 1.0 (0.6–1.5) | 1.02 (0.46–1.05) |
Motor weakness not specified (P) any disc level Stankovic 1999 [59] | 0.60 (0.46–0.72) | 0.38 (0.26–0.51) | 1.0 (0.7–1.3) | 1.07 (0.66–1.7) |
Additional findings reported by more than one study |
Straight Leg Raise (P) L5 or S1 nerves Albeck 1996 [61] | 0.83 (0.72–0.91) | 0.21 (0.09–0.43) | 1.1 (0.8–1.4) | 0.78 (0.28–2.20) |
Straight Leg Raise (P) L5 or S1 nerves Suri 2010 [56] | 0.69 (0.51–0.83) | 0.84 (0.65–0.94) | 4.3 (1.7–11.0) | 0.37 (0.21–0.65) |
Straight Leg Raise (P) L5 nerve Suri 2010 [56] | 0.67 (0.44–0.84) | 0.67 (0.50–0.80) | 2.0 (1.1–3.5) | 0.50 (0.25–1.0) |
Straight Leg Raise (P) L3-L5 discs Knutsson 1961 [58] | 0.96 (0.91–0.98) | 0.10 (0.03–0.30) | 1.1 (0.9–1.2) | 0.43 (0.10–1.94) |
Straight Leg Raise (P) L3-L5 discs Spangfort 1972
[62]
| 0.97 (0.96–0.97) | 0.11 (0.08–0.15) | 1.1 (1.1–1.1) | 0.29 (0.20–0.42) |
Straight Leg Raise (P) L4 or L5 discs Kerr 1988
[55]
| 0.98 (0.93–0.99) | 0.44 (0.30–0.60) | 1.8 (1.3–2.4) | 0.05 (0.01–0.19) |
Straight Leg Raise (P) L4 or L5 discs Gurdjian 1961 [57] | 0.82 (0.80–0.84) | 0.45 (0.35–0.56) | 1.5 (1.2–1.8) | 0.40 (0.30–0.52) |
Straight Leg Raise (P) L3-L5 discs Gurdjian 1961 [57] | 0.81 (0.78–0.83) | 0.37 (0.23–0.54) | 1.2 (1.0–1.7) | 0.52 (0.34–0.81) |
Straight Leg Raise (P) L4-L5 discs Demircan 2002
[71]
| 0.97 (0.94–0.99) | 0.82 (0.73–0.89) | 5.4 (3.6–8.2) | 0.03 (0.01–0.08) |
Straight Leg Raise (P) L3-L5 discs Kosteljanetz 1984 [63] | 0.79 (0.66–0.88) | 0.48 (0.32–0.63) | 1.5 (1.1–2.1) | 0.45 (0.25–0.81) |
Straight Leg Raise (P) any disc level Charnley 1951
[72]
| 0.78 (0.68–0.86) | 0.64 (0.39–0.84) | 2.2 (1.1–4.5) | 0.34 (0.19–0.60) |
Straight Leg Raise(P) any disc level Kosteljanetz 1988
[70]
| 0.89 (0.76–0.96) | 0.14 (0.00–0.58) | 1.0 (0.8–1.4) | 0.78 (0.11–5.71) |
Straight Leg Raise (P) any disc level Hakelius 1972
[64]
| 0.96 (0.95–0.97) | 0.14 (0.11–0.18) | 1.1 (1.1–1.2) | 0.27 (0.19–0.38) |
Straight leg raise (P) any nerve Vroomen 2002 [53] | 0.64 (0.56–0.71) | 0.57 (0.48–0.65) | 1.5 (1.2–1.9) | 0.64 (0.49–0.83) |
Straight leg raise (P) any disc level Majlesi 2008
[73]
| 0.53 (0.37–0.67) | 0.89 (0.75–0.96) | 4.9 (1.8–12.9) | 0.53 (0.37–0.76) |
Straight leg raise (P) any disc level Haldeman 1988
[68]
| 0.44 (0.33–0.57) | 0.78 (0.61–0.89) | 2.0 (1.0–4.2) | 0.71 (0.53–0.94) |
Straight leg raise (P) any disc levela Meylemans 1988
[67]
| 0.35 (0.26–0.44) | 1.00 (0.92–1.00) | NA | 0.65 (0.57–0.75) |
Crossed SLR (P) L5 or S1 nerves Suri 2010 [56] | 0.07 (0.02–0.22) | 0.96 (0.81–0.99) | 1.7 (0.2–18.0) | 0.97 (0.85–1.1) |
Crossed SLR (P) L4 or L5 disc Kerr 1988 [55] | 0.43 (0.34–0.53) | 0.97 (0.86–0.99) | 15.6 (2.2–109.1) | 0.58 (0.49–0.74) |
Crossed SLR (P) L3-L5 discs Spangfort 1972 [62] | 0.23 (0.21–0.25) | 0.88 (0.84–0.91) | 2.0 (1.5–2.6) | 0.87 (0.83–0.91) |
Crossed SLR (P) L3-L5 discs Knutsson 1961 [58] | 0.25 (0.18–0.32) | 0.95 (0.74–1.00) | 4.7 (0.7–32.2) | 0.80 (0.69–0.91) |
Crossed SLR (P) L4-L5 discs Poiraudeau 2001
[69]
| 0.29 (0.16–0.45) | 0.83 (0.66–0.93) | 1.7 (0.7–4.0) | 0.86 (0.68–1.10) |
Crossed SLR (P) any disc level Kosteljanetz 1988 [70] | 0.24 (0.13–0.40) | 1.00 (0.59–1.00) | NA | 0.76 (0.64–0.89) |
Crossed SLR (P) any disc level Stankovic 1999
[59]
| 0.29 (0.18–0.42) | 0.87 (0.75–0.93) | 2.2 (1.0–4.9) | 0.82 (0.67–1.00) |
Slump (P) any disc level Majlesi 2008 [73] | 0.84 (0.74–0.90) | 0.83 (0.73–0.90) | 4.9 (?) | 0.19 (?) |
Slump (P) any disc level Stankovic 1999 [59] | 0.94 (0.84–0.98) | 0.23 (0.13–0.36) | 1.2 (1.0–1.4) | 0. 26 (0.08–0.85) |
Spinal Stenosis |
Cook rule: 3 of 5 positive findings Cook 2011
[76]
| 0.29 (0.27–0.31) | 0.88 (0.87–0.90) | 2.5 (2.0–3.1) | 0.80 (0.76–0.85) |
Age more than 48 years (H) | 0.88 (0.85–0.89) | 0.49 (0.47–0.50) | 1.7 (1.6–1.8) | 0.25 (0.21–0.32) |
Bilateral symptoms (H) | 0.03 (0.02–0.04) | 0.98 (0.98–0.99) | 2.3 (1.1–4.8) | 0.98 (0.97–0.99) |
Leg pain worse than back pain (H) | 0.16 (0.14–0.18) | 0.92 (0.91–0.93) | 2.1 (1.5–2.8) | 0.91 (0.87–0.94) |
Pain with walking/standing (H) | 0.67 (0.64–0.69) | 0.44 (0.42–0.46) | 1.2 (1.1–1.3) | 0.75 (0.66–0.86) |
Sitting relieves pain (H) | 0.26 (0.24–0.29) | 0.86 (0.84–0.88) | 1.9 (1.5–2.3) | 0.86 (0.82–0.91) |
Studies supporting items of the Cook rule |
Age more than 50 years (H) Konno 2007
[84]
| 0.95 (0.90–0.98) | 0.79 (0.70–0.86) | 4.6 (3.10–6.81) | 0.06 (0.03–0.13) |
Bilateral pain (H) Ljunggren 1991
[78]
| 0.51 (0.40–0.62) | 0.92 (0.85–0.96) | 6.3 (3.15–12.74) | 0.54 (0.43–0.68) |
Severe leg pain (H) Katz 1995 [79] | 0.65 (0.51–0.79) | 0.67 (0.51–0.83) | 2.0 (?) | 0.52 (?) |
Symptoms extending down the legs when walking (P) Jensen 1989 [80] | 0.63 (0.31–0.86) | 0.80 (0.55–0.93) | 3.1 (0.99–9.82) | 0.47 (0.19–1.19) |
Leg pain or numbness (H) Konno 2007 [84] | 0.94 (0.90–0.98) | 0.12 (0.07–0.20) | 1.1 (0.99–1.18) | 0.41 (0.17–1.01) |
Radiating leg pain (disc disease with spinal stenosis) (H) Roach 1997 [81] | 0.94 (?) | 0.21 (?) | 1.2 (?) | 0.29 (?) |
Symptoms worse by standing (H) Konno 2007 [84] | 0.85 (0.78–0.90) | 0.75 (0.66–0.83) | 3.4 (2.40–4.88) | 0.20 (0.14–0.31) |
Symptoms exacerbated when standing up (H) Sugioka 2008 [82] | 0.92 (0.87–0.95) | 0.21 (0.15–0.27) | 1.2 (1.06–1.27) | 0.39 (0.22–0.69) |
Walking or standing worst posture (H) Fritz 1997 [83] | 0.88 (0.71–0.96) | 0.33 (0.16–0.56) | 1.3 (0.93–1.89) | 0.35 (0.10–1.21) |
Symptoms worse walking and relieved by rest (H) Konno 2007 [84] | 0.94 (0.89–0.97) | 0.81 (0.73–0.88) | 5.1 (3.34–7.71) | 0.07 (0.04–0.14) |
Pseudoclaudication (H) Roach 1997 [81] | 0.63 (?) | 0.71 (?) | 2.2 (?) | 0.52 (?) |
Sitting best posture (H) Fritz 1997 [83] | 0.89 (0.71–0.96) | 0.39 (0.20–0.61) | 1.5 (0.98–2.15) | 0.29 (0.09–1.0) |
Symptoms improve when seated (H) Katz 1995 [79] | 0.53 (0.37–0.67) | 0.83 (0.70–0.96) | 3.1 (?) | 0.58 (?) |
Studies not supporting items of the Cook rule |
Pain below buttocks (H) Katz 1995 [79] | 0.88 (0.78–0.98) | 0.34 (0.18–0.50) | 1.3 (?) | 0.64 (?) |
Leg pain with walking that is relieved by sitting (H) Fritz 1997 [83] | 0.81 (0.62–0.91) | 0.16 (0.55–0.38) | 0.96 (0.73–1.26) | 1.2 (0.33–4.49) |
Pain worse when walking (H) Katz 1995 [79] | 0.71 (0.57–0.85) | 0.30 (0.14–0.46) | 1.0 (?) | 0.97 (?) |
Intermittent claudication (H) Sugioka 2008 [82] | 0.73 (0.66–0.79) | 0.38 (0.31–0.46) | 1.2 (1.02–1.38) | 0.70 (0.52–0.95) |
Pain occurs while walking (H) Sugioka 2008 [82] | 0.83 (0.77–0.87) | 0.27 (0.21–0.34) | 1.1 (1.01–1.26) | 0.64 (0.44–0.97) |
Additional findings reported by more than one study |
Symptoms improved by bending forward (H) Konno 2007 [84] | 0.72 (0.64–0.79) | 0.92 (0.85–0.96) | 8.8 (4.48–17.15) | 0.30 (0.23–0.40) |
Symptoms improved by bending forward (H) Sugioka 2008 [82] | 0.43 (0.36–0.50) | 0.75 (0.69–0.81) | 1.7 (1.28–2.36) | 0.76 (0.66–0.88) |
No pain with flexion (P) Katz 1995 [79] | 0.79 (0.67–0.91) | 0.44 (0.27–0.61) | 1.4 (?) | 0.48 (?) |
Walking easier bending forward (H) Sugioka 2008 [82] | 0.55 (0.48–0.62) | 0.61 (0.53–0.68) | 1.4 (1.12–1.75) | 0.74 (0.61–0.90) |
Improved treadmill walking tolerance bending forward (Distinguish from PVD) (P) Dong 1989 [85] | 0.58 (0.36–0.77) | 0.82 (0.52–0.95) | 3.2 (0.85–11.81) | 0.52 (0.28–0.93) |
Earlier onset of symptoms with level treadmill walking vs inclined (P) Fritz 1997 [83] | 0.65 (0.46–0.81) | 0.84 (0.62–0.94) | 4.1 (1.41–12.14) | 0.41 (0.23–0.72) |
Symptoms improved by walking uphill (Distinguish from PVD) (H) Dong 1989 [85] | 0.16 (0.55–0.38) | 1.0 (0.74–1.0) | NA | 0.84 (0.69.–1.02) |
Thigh pain with extension (P) Katz 1995 [79] | 0.51 (0.36–0.66) | 0.69 (0.53–0.85) | 1.6 (?) | 0.71 (?) |
Symptoms induced by bending backward (H) Konno 2007 [84] | 0.62 (0.54–0.70) | 0.48 (0.39–0.58) | 1.2 (0.95–1.52) | 0.78 (0.58–1.05) |
Gait abnormality (ataxic, wide based, poor coordination) (P) Cook 2011 [76] | 0.29 (0.27–0.32) | 0.81 (0.79–0.83) | 1.6 (1.2–1.9) | 0.87 (0.82–0.92) |
Wide based gait (P) Katz 1995 [79] | 0.43 (0.28–0.58) | 0.97 (0.91–1.0) | 14.3 (?) | 0.59 (?) |
Spondylolisthesis |
Studies supporting a diagnostic rule |
Manual hypermobility test positive (P) Fritz 2005 [87] | 0.46 (0.30–0.64) | 0.81 (0.60–0.92) | 2.4 (0.9–6.4) | 0.66 (0.44–0.99) |
Lack of manual hypomobility test positive (P) Fritz 2005 [87] | 0.43 (0.27–0.61) | 0.95 (0.77–0.99) | 9.0 (1.3–63.9) | 0.60 (0.43–0.84) |
Lack of manual hypomobility test positive and flexion ROM?>?53° (P) Fritz 2005 [87] | 0.29 (0.13–0.46) | 0.98 (0.91–1.00) | 12.8 (0.8–211.6) | 0.72 (0.55–0.94) |
Manual flexion hypermobility test positive (P) rotation Abbott 2005 [88] | 0.05 (0.01–0.36) | 0.99 (0.96–1.00) | 4.1 (0.2–80.3) | 0.96 (0.83–1.11) |
Manual flexion hypermobility test positive (P)translation Abbott 2005 [88] | 0.05 (0.01–0.22) | 0.99 (0.97–1.00) | 8.7 (0.6–134.7) | 0.96 (0.88–1.05) |
Manual extension hypermobility test positive (P) rotation Abbott 2005 [88] | 0.22 (0.06–0.55) | 0.97 (0.94–0.99) | 8.4 (1.9–37.6) | 0.80 (0.56–1.13) |
Manual extension hypermobility test positive (P) translation Abbott 2005 [88] | 0.16 (0.06–0.38) | 0.98 (0.94–0.99) | 7.1 (1.7–29.2) | 0.86 (0.71–1.05) |
Slipping by palpation (P) Kalpakcioglu 2009 [90] | 0.88 (0.80–0.93) | 1.00 (0.89–1.00) | NA | 0.12 (0.07–0.20) |
Slipping by palpation (P) Collaer 2006 [91] | 0.60 (0.15–0.95) | 0.87 (0.73–0.96) | 4.7 (1.6–13.9) | 0.46 (0.16–1.35) |
Passive lumbar extension test (P) Kasai 2006 [89] | 0.84 (0.70–0.93) | 0.90 (0.82–0.95) | 8.8 (4.5–17.3) | 0.18 (0.08–0.37) |
Passive lumbar extension test (P) Ferrari 2014 [92] | 0.44 (0.29–0.59) | 0.86 (0.67–0.95) | 3.2 (1.1–9.7) | 0.65 (0.47–0.90) |
Studies not supporting a diagnostic rule |
None | | | | |
Additional findings reported by more than one study |
Slipping by inspection (P) Kalpakcioglu 2009 [90] | 0.21 (0.14–0.30) | 1.00 (0.89–1.00) | NA | 0.79 (0.71–0.87) |
Slipping and Sill sign by inspection and palpation (P) Ahn 2015 [93] | 0.81 (0.65–0.91) | 0.89 (0.79–0.95) | 7.4 (3.6–15.2) | 0.21 (0.10–0.44) |
Aberrant movements (P) Fritz 2005 [87] | 0.18 (0.08–0.36) | 0.90 (0.71–0.97) | 1.9 (0.4–8.7) | 0.91 (0.73–1.13) |
Aberrant movements (P) Sundell 2013 [94] | 0.69 (0.42–0.87) | 0.50 (0.25–0.74) | 1.4 (0.7–2.7) | 0.62 (0.23–1.66) |
Fracture |
The Henschke rule 1 out of 3 positive findings: age >70 years, significant trauma, prolonged use of corticosteroids (H) Henschke 2009 [96] | 0.88 (0.47–1.00) | 0.50 (0.47–0.53) | 1.8 (1.3–2.3) | 0.25 (0.04–1.57) |
The Henschke rule 2 out of 3 positive findings (H) Henschke 2009 [96] | 0.63 (0.31–0.86) | 0.96 (0.95–0.97) | 15.5 (8.4–28.4) | 0.39 (0.16–0.96) |
Age >70 years (H) | 0.50 (0.22–0.78) | 0.96 (0.94–0.97) | 11.2 (5.3–23.6) | 0.52 (0.26–1.05) |
Significant trauma (major in young, minor in elderly) (H) | 0.25 (0.07–0.59) | 0.98 (0.96–0.98) | 10.0 (2.9–35.1) | 0.77 (0.52–1.15) |
Prolonged use of corticosteroids (H) | 0.25 (0.07–0.29) | 0.99 (0.99–1.00) | 48.5 (11.5–204) | 0.75 (0.51–1.13) |
Studies supporting items of the Henschke rule |
Age >74 years (H) van den Bosch 2004 [97] | 0.59 (0.48–0.69) | 0.84 (0.82–0.86) | 3.7 (3.0–4.5) | 0.49 (0.38–0.63) |
Trauma (H) Gibson 1992 [98] | 1.00 (0.59–1.00) | 0.51 (0.41–0.62) | 2.1 (1.7–2.5) | 0.00 (NA) |
Trauma (H) Patrick 1983 [99] | 0.80 (0.65–0.90) | 0.55 (0.51–0.59) | 1.8 (1.5–2.1) | 0.36 (0.20–0.68) |
Trauma (H)a Scavone 1981 [103] | 0.65 (0.44–0.83) | 0.95 (0.93–0.96) | 12.8 (8.6–19.2) | 0.37 (0.22–0.62) |
Studies not supporting items of the Henschke rule |
Trauma (H) Deyo 1986 [100] | 0.36 (0.16–0.62) | 0.90 (0.86–0.93) | 3.4 (1.6–7.4) | 0.71 (0.49–1.06) |
Trauma (H) Reinus 1998 [101] | 0.07 (0.02–0.18) | 0.60 (0.56–0.65) | 0.18 (0.07–0.5) | 1.54 (1.38–1.71) |
Using steroids (H) Deyo 1986 [100] | 0.00 (0.00–0.23) | 0.99 (0.98–1.00) | 0.0 (NA) | 1.01 (0.99–1.02) |
Additional findings reported by more than one study |
The Roman rule 2 out of 5 positive findings: age >52 years, no leg pain, body mass index >22, no regular exercise, female gender (H) Roman 2010 [102] | 0.95 (0.83–0.99) | 0.34 (0.33–0.34) | 1.4 (1.3–1.8) | 0.16 (0.04–0.51) |
Female gender (H) van den Bosch 2004 [97] | 0.72 (0.62–0.81) | 0.42 (0.41–0.45) | 1.2 (1.1–1.5) | 0.64 (0.46–0.92) |
Female gender (H) Roman 2010 [102] | 0.89 (0.75–0.97) | 0.41 (0.38–0.44) | 1.5 (1.3–1.7) | 0.26 (0.10–0.65) |
Neurological signs not specified (P) Gibson 1992 [98] | 29 (0.04–0.71) | 0.88 (0.80–0.94) | 2.4 (0.67–8.7) | 0.81 (0.51–1.30) |
Neurological signs not specified (P) Reinus 1998 [101] | 0.05 (0.01–0.15) | 0.92 (0.89–0.94) | 0.7 (0.2–2.2) | 1.03 (0.96–1.10) |
Sensory deficits not specified (P) Patrick 1983 [99] | 0.03 (0.00–0.13) | 0.98 (0.97–0.99) | 1.4 (0.2–10.9) | 0.99 (0.94–1.04) |
Sensory deficits not specified (P)a Scavone 1981 [103] | 0.27 (0.12–0.83) | 0.88 (0.85–0.90) | 2.2 (1.1–4.3) | 0.83 (0.66–1.05) |
Motor deficits not specified (P) Patrick 1983 [99] | 0.02 (0.00–0.13) | 0.99 (0.98–1.00) | 3.1 (0.4–27.3) | 0.98 (0.94–1.03) |
Motor deficits not specified (P)a Scavone 1981 [103] | 0.23 (0.09–0.44) | 0.89 (0.87–0.91) | 2.2 (1.1–4.5) | 0.86 (0.70–1.06) |
Deep tendon reflex abnormality not specified (P) Patrick 1983 [99] | 0.08 (0.02–0.20) | 0.95 (0.93–0.97) | 1.5 (0.5–4.9) | 0.97 (0.89–1.06) |
Deep tendon reflex abnormality not specified (P)a Scavone 1981 [103] | 0.12 (0.02–0.30) | 0.89 (0.87–0.91) | 1.1 (0.4–3.2) | 0.99 (0.86–1.14) |
Tenderness not specified (P) Patrick 1983 [99] | 0.73 (0.56–0.85) | 0.59 (0.54–0.63) | 1.8 (1.4–2.2) | 0.47 (0.28–0.78) |
Tenderness not specified (P)a Scavone 1981 [103] | 0.50 (0.32–0.68) | 0.73 (0.70–0.76) | 1.9 (1.3–2.8) | 0.68 (0.46–1.00) |
Spasm not specified (P) Patrick 1983 [99] | 0.25 (0.13–0.41) | 0.83 (0.79–0.86) | 1.5 (0.83–2.6) | 0.90 (0.75–1.09) |
Spasm not specified (P)a Scavone 1981 [103] | 0.12 (0.04–0.29) | 0.91 (0.89–0.93) | 1.3 (0.4–3.7) | 0.98 (0.85–1.12) |
