Abstract
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. 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 6-12weeks 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. 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. 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.
Highlights
The diagnosis of sciatica is based on history taking and physical examination
The highest Diagnostic odds ratio (DORs) was observed for the answer option ‘worsening of leg pain’ with a DOR of 2.28 for the presence of nerve root compression and a DOR of 2.50 for the presence of a herniated disc on magnetic resonance imaging (MRI)
The diagnostic accuracy of history items to assess the presence of disc herniation or nerve root compression on magnetic resonance imaging (MRI) in 395 patients with severe sciatica was investigated by our research group [2]
Summary
The diagnosis of sciatica is based on history taking and physical examination. A recent Cochrane review showed poor diagnostic performance of most physical tests when used in isolation to identify lumbar disc herniation [1]. The diagnostic accuracy of history items to assess the presence of disc herniation or nerve root compression on magnetic resonance imaging (MRI) in 395 patients with severe sciatica was investigated by our research group [2]. ‘Male gender’, ‘pain worse in the leg than in back’ and ‘a non-sudden-onset’ were significantly associated with the presence of nerve root compression on MRI and ‘body mass index \30’, ‘a non-sudden onset’, and ‘sensory loss’. Eur Spine J (2016) 25:1389–1392 significantly contributed to the diagnosis of a herniated disc on MRI [2]. Just a few trials investigated the diagnostic accuracy of history items, two previous studies did report a significant diagnostic value for this history item [3, 4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
