What are the valid clinical tests for diagnosis of a lumbar disc prolapse? A patient is referred with a suspected disc prolapse. You wish to know which are the best clinical questions/ tests to confirm the diagnosis.
Search Strategy
Medline 1966-09 using the PubMed Clinical queries database was searched using the following terms (Broad Therapy Filter = ((clinical[Abstract] AND trial[Abstract]) OR clinical trials[disc prolapse, disc herneation and clinical tests, examination] OR clinical trial[Journal] OR random*[Abstract] OR random allocation[disc prolapse, disc pain,] OR therapeutic use[surgery, conservative management]). In addition the BestBETS database was searched using similar terms. Finally, the PEDrO (Physiotherapy best evidence) database was searched, as above, with only papers already rated as 7/10 on the quality score being selected for inclusion.
Search Outcome
Altogether 1000 abstracts were identified from the combined searches, after duplicates had been
removed. Abstracts were screened in teams of two. Full papers were obtained for those papers
that answered, or potentially answered the three part search question. This resulted in 4 papers
being obtained. These papers were rated for quality and risk of bias using a standard proforma
(See appendix 1) with papers scoring over 5/10 being summarised in Table 1. This process
resulted in four papers being rated as good quality and directly answering the PICO question
Comments
The reviews included some studies of poor methodological quality and sometimes with
no gold standard documented. This does reduce the validity of the results. The high LR
of the CSLR in the Vroomen et al systematic review (1999) has not been reproduced in
subsequent studies.
Clinical Bottom Line
Crossed straight leg raise is the most useful clinical test in the diagnosis of a Lumbar disc
prolapse. Slump test and paresis is moderately helpful in diagnosis. In terms of subjective
features pain that is worse in the leg than the back may help predict the presence of a disc
prolapse.
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