The Diagnostic Accuracy of Gluteal Trigger Points to Differentiate Radicular From Nonradicular Low Back Pain.

Abstract

Low back pain (LBP) is highly prevalent and costly to the society. Previous studies have shown an association between radicular LBP and trigger points (TrPs) in the superior-lateral quadrant of the gluteal area (GTrP). The objective of current study was to evaluate the diagnostic value of GTrP to predict nerve root involvement among patients with LBP. In a prospective, diagnostic accuracy study 325 consecutive patients with LBP were recruited. At first step, patients were evaluated for the presence or absence of the GTrP. A different investigator, blinded to the GTrP findings, then performed history taking and physical examination. Subsequently, all patients underwent a lumbar spine magnetic resonance imaging and, when indicated, electrodiagnostic tests. On the basis of the clinical and ancillary tests findings, a multidisciplinary panel of experts (the "reference standard"), blinded to the GTrP evaluation, allocated patients to radicular versus nonradicular LBP groups. The agreement between the GTrP findings, as a diagnostic test and the reference standard allocation was evaluated in a 2 by 2 contingency table. The specificity of the GTrP test was 91.4% and its sensitivity was 74.1%. The area under the receiver operating characteristic curve was 0.827 (0.781 to 0.874). Positive likelihood ratio was 8.62 and negative likelihood ratio was 0.28. Positive and negative predictive values were 91.9% and 72.7%, respectively. As a clinical finding, TrPs in superior-lateral quadrant of gluteal area are highly specific indicators for radicular LBP. Incorporating these TrPs evaluation in routine physical examination of patients with LBP could decrease the need for more costly, time-consuming, and invasive diagnostic tests.