Relative efficacy of clinical examination, electromyography, plain film radiography, myelography and lumbar phlebography in the diagnosis of low back pain and sciatica

1979 ◽  
Vol 18 (3) ◽  
pp. 109-118 ◽  
Author(s):  
W. Van Damme ◽  
G. Hessels ◽  
M. Verhelst ◽  
L. Van Laer ◽  
I. Van Es
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Examination ◽  
Plain Film ◽  
Low Back ◽  
Relative Efficacy ◽  
Plain Film Radiography

scholarly journals Symptoms and signs possibly indicating segmental, discogenic pain. A fusion study with 18 years of follow-up

2017 ◽  
Vol 16 (1) ◽  
pp. 213-220 ◽  
Author(s):  
Bo Nyström ◽  
Henrik Weber ◽  
Birgitta Schillberg ◽  
Adam Taube
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Examination ◽  
Prospective Studies ◽  
Chronic Low Back Pain ◽  
Full Time ◽  
Low Back ◽  
Discogenic Pain ◽  
Fusion Surgery ◽  
Symptoms And Signs

AbstractBackgroundOnly two out of the five existing randomized studies have reported better results from fusion surgery for chronic low back pain (CLBP) compared to conservative treatment. In these studies the back symptoms of the patients were described simply as “chronic low back pain”. One possible reason for the modest results of surgery is the lack of a description of specified symptoms that might be related to a painful segment/disc, and patient selection may therefore be more or less a matter of chance. Previous prospective studies including facet joint injections and discography and eventually MRI have failed to identify patients with a painful segment/disc that will benefit from fusion surgery.PurposeOur purpose was to analyse in detail the pre-operative symptoms and signs presented by patients who showed substantial relief from their back pain following spinal fusion surgery with the aim of possibly finding a pain pattern indicating segmental, discogenic pain.MethodsWe analysed 40 consecutive patients, mean age 41 years, with a history of disabling low back pain for a mean of 7.7 years. Before surgery the patients completed a detailed questionnaire concerning various aspects of their back pain, and findings at clinical examination were thoroughly noted. Monosegmental posterior lumbar interbody fusion without internal fixation was performed using microsurgical technique. Outcome was assessed at 1, 2 and 4 years after surgery and finally at 18 years, using selfreporting measures and assessment by an independent examiner. Assessment at 18 years applied the Balanced Inventory for Spinal Disorders Questionnaire and the Roland-Morris Disability Questionnaire.ResultsAccording to the independent observer’s assessment at two years 27 of the 40 patients were much improved. Analysis of the pre-operative depiction of the back symptoms of this group revealed a rather uniform pattern, the most important being: dominating back pain originating in the midline of the spine, with a dull, aching character and stabbing pain in the same area provoked by sudden movements. Most patients in this group also had diffuse pain radiation of various extension down one or both legs and often bladder dysfunction with frequency. At clinical examination, localized interspinal tenderness was observed within the spinal area in question and the patient’s back pain was provoked by pressure in that area and by tapping a neighbouring spinous process.At 18 years after surgery 19 patients assessed themselves as much improved. At that time 5 of them had pension due to age, 7 early pension, one worked full time and six patients part time. Eleven patients were re-operated due to defect bony healing.ConclusionsThe results may suggest that the use of a detailed symptom analysis and clinical examination may make it possible to select a subgroup of patients within the CLBP group likely to have better outcome following fusion surgery.ImplicationsThe next step would be to execute prospective studies and if our findings concerning back pain details and signs among CLPB patients can be confirmed this can provide for more accurate selection of patients suitable for fusion surgery.

scholarly journals Agreement of clinical examination for low back pain with facet joint origin

2018 ◽  
Vol 38 (02) ◽  
pp. 125-131 ◽  
Author(s):  
Mantana Vongsirinavarat ◽  
Wahyuddin Wahyuddin ◽  
Ratchaneewan Adisaiphaopan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Criteria ◽  
Clinical Examination ◽  
Facet Joint ◽  
Physical Therapists ◽  
Operational Definition ◽  
Low Back ◽  
Low Level ◽  
Common Diagnosis

Background: Low back pain (LBP) with facet joint origin is a common diagnosis of patients referred to physical therapy clinic. An expert consensus of diagnostic criteria has been proposed. However, the reliability of the assessment has not been proved. Objective: To test the degrees of agreement between two physical therapists for nine physical examination items and the diagnosis of facet joint origin. Methods: The examination according to diagnostic criteria was performed independently by two physical therapists in 45 patients with chronic LBP. The percent agreements and Kappa coefficients of each examination item and diagnostic conclusion were calculated. Results: The percent agreements of nine examined items ranged from 73.3–91.1%. The Kappa coefficients, widely ranged from 0.250–0.690 ([Formula: see text] to [Formula: see text]), showed statistically significant agreements for all examination items. The low level of agreements was partly due to improper distributions of test results. The agreement of conclusion was 86.7% and Kappa coefficient was 0.492 ([Formula: see text]) which reflected good agreement of facet diagnosis. Conclusion: There were adequate agreements for clinical examination of LBP with facet joint origin. The low level of agreement suggested the clinicians to have operational definition and rigorous training sessions although the examinations seemed to be routinely performed.

scholarly journals DEVELOPMENT OF A CLINICAL EXAMINATION IN NON-SPECIFIC LOW BACK PAIN: A DELPHI TECHNIQUE

2006 ◽  
Vol 38 (4) ◽  
pp. 263-267 ◽  
Author(s):  
Christopher McCarthy ◽  
Alison Rushton ◽  
Vicky Billis ◽  
Frances Arnall ◽  
Jacqueline Oldham
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Examination ◽  
Delphi Technique ◽  
Low Back
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