Table 1:
Category | Definition | Key Findings | Diagnostic Standard Used | Performance Statistics9 | References |
---|---|---|---|---|---|
Screening | Findings indicating recent injury, special testing, referral or need for emergent evaluation | Evidence of possible fracture, progressive neurologic deficit, infection, tumor… | N/A1 | N/A1 | Chou 2007 Dagenais, 2010 Hawk, 2010 Murphy, 2007 |
Nociceptive | Pain from noxious stimulation (inflammation, compression, injury) of peripheral tissues | ||||
Discogenic | Pain from the posterior annulus and near the endplate |
| Lumbar discography |
|
|
Sacroiliac Joint (SI-joint) | Pain from the sacroiliac joint and/or supporting ligaments | SI-joint area pain with 3 or more of: L & R Gaenslen’s2, Thigh Thrust3, Sacral Thrust4, Iliac Comp5, Distraction6 | Flouroscopically-guided, controlled anesthetic block | +LR 4.3 for 3 or more positive tests | Laslett, 2005 |
Zygapophyseal Joint (Z-joint) | Pain from Z-joint structures including the joint capsule and subchondral bone | 3 or more: > Age 50, relief by walking, relief by sitting, paraspinal onset, positive extension-rotation test | Flouroscopically-guided, controlled anesthetic block | +LR 9.7 | Laslett, 2006 |
Myofascial | Pain from muscles, tendons, and/or fascial tissue in the low back | Pain with use of involved muscle and trigger points | None | N/A1 | Bennett, 2007 |
Neuropathic | Pain from peripheral or central nervous system tissues | ||||
Compressive Radiculopathy | Pain from compression and inflammation of a nerve root |
| 1.– 5. Clinical findings in individuals with nerve root compression confirmed by Magnetic Resonance Imaging 6. Expert opinion |
| 1–5. Vroomen, 2002 Bennett, 2001 |
Non-compressive Radiculopathy | Pain from compression, stretch and/or inflammation of peripheral nerve structures |
|
|
|
|
Neurogenic Claudication | Pain from ischemia/compression of individual nerve roots, the cauda equina or spinal cord |
| 1.– 4. Expert opinion 5. Doppler Ultrasound | 1.–4. +LR 3.9 for a score of ? 7 on clinical prediction rule (see appendix for scoring) 5. Sensitivity71 ??Specificity 91 | 1.–4. Sugioka, 2008 5. Carmo, 2008 |
Central | Pain from a lesion or dysfunction within the central nervous system |
| Expert opinion |
| Smart, 2012 |
Functional Instability | Disruption of neuromuscular control of a spinal joint neutral zone during normal physiologic demand |
| Radiographic measurements of intervertebral motion |
|
|
Other Diagnoses | Diagnoses not categorized above | Dependent on suspected condition | N/A1 | N/A1 | N/A1 |
1.N/A: Not applicable or not available;
2.Patient
lies supine at the edge of a table with one leg hanging off. The
examiner applies downward pressure to the knee of the hanging leg while
pressing the opposite knee (flexed) toward the patient’s chest.
3.Patient
lies supine with hip flexed to 90 degrees. With one hand, the examiner
cups the sacrum and holds the comfortably flexed knee with the other.
Pressure is applied along the femur shaft.
4.Patient lies prone while examiner manually applies an anterior pressure on the sacrum.
5.Patient
is side-lying with hips and knees flexed to 90 degrees. The examiner
applies medially oriented pressure on the upper iliac crest.
6.Patient lies supine while examiner manually presses posteriorly on the anterior superior iliac spines.
7.Leeds Assessment for Neuropathic Symptoms and Signs
8.With
patient in prone position, both lower extremities are passively
elevated 30 cm with knees extended. Positive test causes LBP.
9.+LR
= (Positive Likelihood Ratio) Probability of the finding in patients
with condition divided by the probability of the finding in patients
without condition. Greater than 1 indicates test is associated with
condition. Higher numbers indicate greater probability of association.
PPV = (Positive Predictive Value) The number of true positives divided
by the sum of true and false positives, indicating the probability that a
positive test is truly positive for a condition. Higher numbers
indicate greater diagnostic strength or accuracy. OR = (Odds Ratio or
Diagnostic Odds Ratio [DOR]) A ratio measuring effectiveness of a
diagnostic test. OR greater than 1 indicates ability to predict
diagnosis. Higher numbers indicate greater diagnostic strength or
accuracy. Sensitivity = percentage of individuals with a condition who
test positive for that condition. Specificity = percentage of
individuals who do not have a condition are identified as negative by
the test