A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI
| Autor: | Jan Mens, Wilco C. Peul, Annemieke J. H. Verwoerd, Arianne P. Verhagen, Abdelilah el Barzouhi, Bart W. Koes |
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| Přispěvatelé: | General Practice, Rehabilitation Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Pain Sneezing Intervertebral disc displacement 03 medical and health sciences Sciatica 0302 clinical medicine Diagnosis medicine Back pain Humans Orthopedics and Sports Medicine Medical history In patient 030212 general & internal medicine Radiculopathy Medical history taking medicine.diagnostic_test business.industry 0903 Biomedical Engineering 1103 Clinical Sciences Magnetic resonance imaging Middle Aged Magnetic Resonance Imaging Surgery Orthopedics Cough Anesthesia Diagnostic odds ratio Specificity Female Neurosurgery medicine.symptom business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | European Spine Journal, 25(5), 1389-1392. SPRINGER European Spine Journal, 25(5), 1389-1392. Springer-Verlag |
| ISSN: | 0940-6719 |
| Popis: | PURPOSE: To test whether the localization of worsening of pain during coughing, sneezing and straining matters in the assessment of lumbosacral nerve root compression or disc herniation on MRI. METHODS: Recently the diagnostic accuracy of history items to assess disc herniation or nerve root compression on magnetic resonance imaging (MRI) was investigated. A total of 395 adult patients with severe sciatica of 6-12 weeks duration were included in this study. The question regarding the influence of coughing, sneezing and straining on the intensity of pain could be answered on a 4 point scale: no worsening of pain, worsening of back pain, worsening of leg pain, worsening of back and leg pain. Diagnostic odds ratio's (DORs) were calculated for the various dichotomization options. RESULTS: The DOR changed into significant values when the answer option was more narrowed to worsening of leg pain. The highest DOR was observed for the answer option 'worsening of leg pain' with a DOR of 2.28 (95 % CI 1.28-4.04) for the presence of nerve root compression and a DOR of 2.50 (95 % CI 1.27-4.90) for the presence of a herniated disc on MRI. CONCLUSIONS: Worsening of leg pain during coughing, sneezing or straining has a significant diagnostic value for the presence of nerve root compression and disc herniation on MRI in patients with sciatica. This study also highlights the importance of the formulation of answer options in history taking. |
| Databáze: | OpenAIRE |
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