Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression
Open accessAbstract
OBJECTIVE: To evaluate patient characteristics, symptoms, and examination findings in the clinical diagnosis of lumbosacral nerve root compression causing sciatica. METHODS: The study involved 274 patients with pain radiating into the leg. All had a standardised clinical assessment and magnetic resonance (MR) imaging. The associations between patient characteristics, clinical findings, and lumbosacral nerve root compression on MR imaging were analysed. RESULTS: Nerve root compression was associated with three patient characteristics, three symptoms, and four physical examination findings (paresis, absence of tendon reflexes, a positive straight leg raising test, and increased finger-floor distance). Multivariate analysis, analysing the independent diagnostic value of the tests, showed that nerve root compression was predicted by two patient characteristics, four symptoms, and two signs (increased finger-floor distance and paresis). The straight leg raise test was not predictive. The area under the curve of the receiver-operating characteristic was 0.80 for the history items. It increased to 0.83 when the physical examination items were added. CONCLUSIONS: Various clinical findings were found to be associated with nerve root compression on MR imaging. While this set of findings agrees well with those commonly used in daily practice, the tests tended to have lower sensitivity and specificity than previously reported. Stepwise multivariate analysis showed that most of the diagnostic information revealed by physical examination findings had already been revealed by the history items.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
L3-L4 lesions affect PTR.
“Specifically, L3-L4 lesions affect PTR [19,20], whereas S1 lesions influence ATR [21].”
From The usefulness of deep tendon reflexes in the diagnosis of lumbar spine diseases: a narrative review (2024) · cites this paper as [19]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Practical Statistics for Medical Research.
Walter, S., & Altman, D. G. (1992) · Biometrics · doi:10.2307/2532320 · Cited by 11,665 · see citing works
Practical Statistics for Medical Research
Altman, D. G. (1990) · doi:10.1201/9780429258589 · Cited by 10,668 · see citing works
Basic principles of ROC analysis
Metz, C. E. (1978) · Seminars in Nuclear Medicine · doi:10.1016/s0001-2998(78)80014-2 · Cited by 6,058 · see citing works
Practical Statistics for Medical Research.
Bartko, J. J., & Altman, D. G. (1992) · Journal of the American Statistical Association · doi:10.2307/2290246 · Cited by 4,834 · see citing works
Clinical Epidemiology: A Basic Science for Clinical Medicine.
(1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-114-9-825_9 · Cited by 3,497 · see citing works
Boden, S. D., McCowin, P. R., Davis, D. O., Dina, T. S., Mark, A. S., & Wiesel, S. W. (1990) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-199072080-00008 · Cited by 2,698 · see citing works
Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain
Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N. A., Modic, M. T., Malkasian, D. R., & Ross, J. S. (1994) · New England Journal of Medicine · doi:10.1056/nejm199407143310201 · Cited by 2,381 · see citing works
Boden, S. D., Davis, D. O., Dina, T. S., Patronas, N. J., & Wiesel, S. W. (1990) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-199072030-00013 · Cited by 2,103 · see citing works
Rupture of the Intervertebral Disc with Involvement of the Spinal Canal
Mixter, W. J., & Barr, J. S. (1934) · New England Journal of Medicine · doi:10.1056/nejm193408022110506 · Cited by 1,918 · see citing works
Problems of Spectrum and Bias in Evaluating the Efficacy of Diagnostic Tests
Ransohoff, D. F., & Feinstein, A. R. (1978) · New England Journal of Medicine · doi:10.1056/nejm197810262991705 · Cited by 1,739 · see citing works
Logistic Regression: A Self-Learning Text.
Selvin, S., & Kleinbaum, D. G. (1996) · Journal of the American Statistical Association · doi:10.2307/2291427 · Cited by 1,628 · see citing works
Weber, H. (1983) · Spine · doi:10.1097/00007632-198303000-00003 · Cited by 1,154 · see citing works
Clinical Epidemiology: The Architecture of Clinical Research.
(1985) · Annals of Internal Medicine · doi:10.7326/0003-4819-103-4-649_2 · Cited by 954 · see citing works
A 10-year follow-up of the outcome of lumbar microdiscectomy.
Findlay, G. F., Hall, B. I., Musa, B. S., Oliveira, M. D., & Fear, S. C. (1981) · PubMed · doi:10.1097/00007632-199805150-00019 · Cited by 797 · see citing works
Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects
Boden, S. D., Dina, T. S., Patronas, N. J., & Wiesel, S. W. (1990) · Cited by 770 · see citing works
Receiver operating characteristic (ROC) methodology: the state of the art.
Hanley, J. A. (1989) · PubMed · Cited by 685 · see citing works
Logistic Regression: A Self-Learning Text
Kianifard, F., & Kleinbaum, D. G. (1995) · Technometrics · doi:10.2307/1269163 · Cited by 505 · see citing works
Abnormal Myelograms in Asymptomatic Patients
Hitselberger, W. E., & Witten, R. M. (1968) · Journal of neurosurgery · doi:10.3171/jns.1968.28.3.0204 · Cited by 362 · see citing works
Bozzao, A., Gallucci, M., Masciocchi, C., et al. (1992) · Radiology · doi:10.1148/radiology.185.1.1523297 · Cited by 292 · see citing works
Lachs, M. S., Nachamkin, I., Edelstein, P. H., Goldman, J., Feinstein, A. R., & Schwartz, J. S. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-117-2-135 · Cited by 259 · see citing works
Lack of Effectiveness of Bed Rest for Sciatica
Vroomen, P. C. A. J., de Krom, M. C. T. F. M., Wilmink, J. T., Kester, A. D. M., & Knottnerus, J. A. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902113400602 · Cited by 224 · see citing works
Self-citationKanemoto, M., Hukuda, S., Komiya, Y., et al. (1996) · Spine · doi:10.1097/00007632-199601010-00001 · Cited by 182 · see citing works
Rupture of the Intervertebral Disc with Involvement of the Spinal Canal
Mixter, W. J., & Barr, J. S. (1964) · Journal of neurosurgery · doi:10.3171/jns.1964.21.1.0074 · Cited by 180 · see citing works
Vroomen, P. C. A. J., de Krom, M. C. T. F. M., & Knottnerus, J. A. (1999) · Journal of Neurology · doi:10.1007/s004150050480 · Cited by 168 · see citing works
Self-citationSurgery for herniated lumbar discs: A literature synthesis
Hoffman, R. M., Wheeler, K. J., & Deyo, R. A. (1993) · Journal of General Internal Medicine · doi:10.1007/bf02600110 · Cited by 152 · see citing works
van den Hoogen, H. M. M., Koes, B. W., van Eijk, J. T. M., & Bouter, L. M. (1995) · Spine · doi:10.1097/00007632-199502000-00010 · Cited by 146 · see citing works
The Neuroradiographic Diagnosis of Lumbar Herniated Nucleus Pulposus: II
Jackson, R. P., Cain, J. E., Jacobs, R. R., et al. (1989) · Spine · doi:10.1097/00007632-198912000-00013 · Cited by 141 · see citing works
The influence of referral patterns on the characteristics of diagnostic tests
AndréKnorrnerus, J., & Leffers, P. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90155-g · Cited by 140 · see citing works
Clinical epidemiology: The architecture of clinical research
Feinstein, A. R. (1995) · Statistics in Medicine · doi:10.1002/sim.4780141110 · Cited by 132 · see citing works
▪ History and Physical Examination in Patients With Herniated Lumbar Discs
Andersson, G. B. J., & Deyo, R. A. (1996) · Spine · doi:10.1097/00007632-199612151-00003 · Cited by 112 · see citing works
Knutsson, B. (1961) · Acta Orthopaedica Scandinavica · doi:10.3109/ort.1961.32.suppl-49.01 · Cited by 100 · see citing works
MEASURES OF GAIN IN CERTAINTY FROM A DIAGNOSTIC TEST
Koepsell, T. D., & CONNELL, F. A. (1985) · American Journal of Epidemiology · doi:10.1093/aje/121.5.744 · Cited by 96 · see citing works
Magnetic Resonance Imaging of the Lumbar Spine -- Terrific Test or Tar Baby?
Deyo, R. A. (1994) · New England Journal of Medicine · doi:10.1056/nejm199407143310209 · Cited by 92 · see citing works
Bischoff, R. J., Rodriguez, R. P., Gupta, K. L., et al. (1993) · Journal of Spinal Disorders · doi:10.1097/00002517-199306040-00002 · Cited by 92 · see citing works
The Effects of Disease Verification and Referral on the Relationship Between Symptoms and Diseases
Knottnerus, J. A. (1987) · Medical Decision Making · doi:10.1177/0272989x8700700304 · Cited by 91 · see citing works
Vroomen, P. C. A. J., de Krom, M. C. T. F. M., & Knottnerus, J. A. (2000) · Spine · doi:10.1097/00007632-200001010-00016 · Cited by 89 · see citing works
Self-citation▪ The Radiologic Assessment for a Lumbar Disc Herniation
Herzog, R. J. (1996) · Spine · doi:10.1097/00007632-199612151-00004 · Cited by 79 · see citing works
Predictive value of clinical and surgical findings in patients with lumbago-sciatica
Kosteljanetz, M., Espersen, J. O., Halaburt, H., et al. (1984) · Acta Neurochirurgica · doi:10.1007/bf01401785 · Cited by 72 · see citing works
The value of accurate clinical assessment in the surgical management of the lumbar disc protrusion.
Kerr, R. S. C., Cadoux-Hudson, T. A. D., & Adams, C. B. T. (1988) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.51.2.169 · Cited by 59 · see citing works
Lumbar Disc Herniation: A Controlled, Prospective Study with Ten Years of Observation
Baker, A. D. L. (2013) · Springer eBooks · doi:10.1007/978-1-4471-5451-8_62 · Cited by 51 · see citing works
Szypryt, E. P., Twining, P., Wilde, G., et al. (1988) · Journal of Bone and Joint Surgery - British Volume · doi:10.1302/0301-620x.70b5.3192567 · Cited by 26 · see citing works
Optimising the image of the intradural nerve root: the value of MR radiculography
Hofman, P. A. M., & Wilmink, J. T. (1996) · Neuroradiology · doi:10.1007/s002340050327 · Cited by 22 · see citing works
Receiver Operating Characteristic (ROC) anaylsis
Cleves, M. A. (2000) · Stata technical bulletin · Cited by 18 · see citing works
Andersson, G. B. J., & Weinstein, J. N. (1996) · Spine · doi:10.1097/00007632-199612151-00001 · Cited by 14 · see citing works
Didry, C., Lopez, P., Baixas, P., et al. (1991) · PubMed · Cited by 8 · see citing works
Moens, H. J. B., Hirshberg, A. J., & Claessens, A. A. M. C. (1992) · Medical Decision Making · doi:10.1177/0272989x9201200402 · Cited by 7 · see citing works
MR imaging of the low back syndrome
Ellenberger, C. (1994) · Neurology · doi:10.1212/wnl.44.4.594 · Cited by 6 · see citing works
Andersson, G., & Weinstein, J. N. (1996) · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Vroomen PCAJ, de Krom MCTFM, Knottnerus JA. The consistency of the history and the physical examination in the patient suspected of sciatica. Spine 2000;25:91-6.
- Szypryt ET, Twining P, Wilde GP, et al. Diagnosis of lumbar disc protrusion. J Bone Joint Surg Br 1988;70:717-22.
Cited by
Sorted by citations
Suri, P., Rainville, J., Katz, J. N., Jouve, C., Hartigan, C., Limke, J., Pena, E., Li, L., Swaim, B., & Hunter, D. J. (2011) · Spine · doi:10.1097/brs.0b013e3181c953cc · Cited by 89 · see citing works
Accuracy of physical examination for chronic lumbar radiculopathy
Iversen, T., Solberg, T. K., Romner, B., Wilsgaard, T., Nygaard, Ø., Waterloo, K., Brox, J. I., & Ingebrigtsen, T. (2013) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-14-206 · Cited by 67 · see citing works
The usefulness of deep tendon reflexes in the diagnosis of lumbar spine diseases: a narrative review
Morimoto, T., Hirata, H., Watanabe, K., Kato, K., Otani, K., Mawatari, M., & Nikaido, T. (2024) · Cureus · doi:10.7759/cureus.55772 · Cited by 3 · see citing works
- Authors
- Vroomen, P. C. A. J.
- Affiliations
- Maastricht University Medical Centre (NL)
- Corresponding author
- Vroomen, P C A J
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2002-05-01
- Volume
- 72
- Issue
- 5
- Pages
- 630-634
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC1737860
- OpenAlex
- W2120027121
- Cited by
- 214
- References
- 48
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 8 · 2023: 15 · 2022: 9 · 2021: 10 · 2020: 13 · 2019: 5 · 2018: 10 · 2017: 10 · 2016: 8 · 2015: 4 · 2014: 10 · 2013: 17 · 2012: 8
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Peripheral Nerve Disorders
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- lumbosacral nerve root compression, sciatica, diagnosis, physical examination, medical history, magnetic resonance imaging, straight leg raising test, paresis, deep tendon reflexes, diagnostic accuracy, leg pain
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Male, Medical History Taking, Middle Aged, Neurologic Examination, Physical Examination, Predictive Value of Tests, Radiculopathy, Sciatica, Sensitivity and Specificity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
