Use of Neurodynamic or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity.

Francisco Javier González Espinosa De Los Monteros,Gloria Gonzalez-Medina,José Paz Expósito,Juan Rodríguez Mansilla,Elisa Maria Garrido Ardila,Petronila Oliva Ruiz

doi:10.3390/ijerph17197046

Abstract

Background: Lumbar radiculopathy is a nerve root disorder whose correct diagnosis is essential. The objective of the present study was to analyze the reliability diagnostic validity of eight neurodynamic and/or orthopedic tension tests using magnetic resonance imaging as the Gold Standard. Methods: An epidemiological study of randomized consecutive cases which was observational, descriptive, transversal, double blinded and was conducted following the Standards for Reporting Diagnostic accuracy studies (STARD) declaration. The sample size was 864 participants. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The diagnostic validity of the combined and multiple tests in parallel was also calculated. Results: The analysis indicated that only two tests performed independently had external validity, but neither had reliability or precision. The Straight Leg Raise test and the Bragard test performed in a multiple parallel way showed high sensitivity (97.40%), high negative predictive value (PV− 96.64%) and external validity (Likelihood Ratio− 0.05). The combined test of the Slump test and the Dejerine’s triad had internal and external validity. Conclusions: The Straight Leg Raise test and the Bragard test performed in a multiple parallel way and the combined test of the Slump Test and the Dejerine’s triad have clinical validity to discard lumbar or lumbar-sacral radiculopathy.

Highlights

Lumbar radiculopathy is a dysfunction of the spinal nerve root that can be accompanied by pain, weakness, sensitivity and reflex disorders in the affected anatomical area [1]
We developed this research, with the aim of estimating the diagnostic validity of the following orthopedic stress tests and/or neurodynamic tests: Straight Leg Raise Test (SLR) or Leg Elevation Test Extended [14,16], Bragard test (B) [17], Fajersztajn test (F) [18,19], Sicard test (S) [19], Passive Neck Flexion test (PNFT) [10], Kernig (K) [20], Slump Test (S) [21] and Dejerine’s triad (DT) [19]
Out of all the tests assessed in this study, only the combined test of Slump test and the Dejerine’s triad and the Straight Leg Raise and Bragard test performed in the multiple parallel way had diagnostic validity

Summary

Introduction

Lumbar radiculopathy is a dysfunction of the spinal nerve root that can be accompanied by pain, weakness, sensitivity and reflex disorders in the affected anatomical area [1]. These symptoms, in particular pain, cause a negative impact on the independence of the person which is a problem in today’s society [2]. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The Straight Leg Raise test and the Bragard test performed in a multiple parallel way showed high sensitivity (97.40%), high negative predictive value (PV− 96.64%) and external validity (Likelihood Ratio− 0.05).

Objectives

Discussion

Conclusion