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 midline^a (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 block^a 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 block^a 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 block^a 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 block^a 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 level^a 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)