Spinal Stenosis

Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study

The Chiro.Org Blog

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SOURCE:   Spine (Phila Pa 1976). 2016 (Aug 1); 41 (15): 1239–1246

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Christy Tomkins-Lane, PhD, Markus Melloh, MD, PhD, Jon Lurie, MD, et. al.

Department of Health and Physical Education,
Mount Royal University,
Calgary, Canada

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STUDY DESIGN:   Delphi.

OBJECTIVE:   The aim of this study was to obtain an expert consensus on which history factors are most important in the clinical diagnosis of lumbar spinal stenosis (LSS).

SUMMARY OF BACKGROUND DATA:   LSS is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.

METHODS:   Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An online survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.

RESULTS:   A total of 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated.

The six top items were

“leg or buttock pain while walking,”
“flex forward to relieve symptoms,”
“feel relief when using a shopping cart or bicycle,”
“motor or sensory disturbance while walking,”
“normal and symmetric foot pulses,”
“lower extremity weakness,” and
“low back pain.”Significant change in certainty ceased after six questions at 80% (P < .05).

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A Non-surgical Approach to the Management of Lumbar Spinal Stenosis: A Prospective Observational Cohort Study

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SOURCE:   BMC Musculoskelet Disord. 2006 (Feb 23); 7: 16

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Donald R Murphy, Eric L Hurwitz,
Amy A Gregory, and Ronald Clary

Rhode Island Spine Center,
Pawtucket, RI 02860, USA.

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BACKGROUND:   While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM).

METHODS:   This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with lumbar spinal stenosis (LSS). Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement.

RESULTS:   The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in “on average” pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in “at worst” pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in “on average” pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in “at worst” pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted.

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