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New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion.

Ahn K, Jhun HJ - BMC Musculoskelet Disord (2015)

Bottom Line: The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively.Positive and negative predictive values of the test were 77.1% and 68.0%, respectively.The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.

View Article: PubMed Central - PubMed

Affiliation: Ahnkang Pain Free Hospital, CHA University, 323 Nonhyeon-Ro, 135-930, Kangnam-Ku, Seoul, Republic of Korea. kangahn2003@gmail.com.

ABSTRACT

Background: Lumbar spondylolisthesis (LS) and lumbar instability (LI) are common disorders in patients with low back or lumbar radicular pain. However, few physical examination tests for LS and LI have been reported. In the study described herein, new physical examination tests for LS and LI were devised and evaluated for their validity. The test for LS was designated "low midline sill sign", and that for LI was designated "interspinous gap change" during lumbar flexion-extension motion.

Methods: The validity of the low midline sill sign was evaluated in 96 patients with low back or lumbar radicular pain. Validity of the interspinous gap change during lumbar flexion-extension motion was evaluated in 73 patients with low back or lumbar radicular pain. The sensitivity, specificity, and positive and negative predictive values of the two tests were also investigated.

Results: The sensitivity and specificity of the low midline sill sign for LS were 81.3% and 89.1%, respectively. Positive and negative predictive values of the test were 78.8% and 90.5%, respectively. The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively. Positive and negative predictive values of the test were 77.1% and 68.0%, respectively.

Conclusions: The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.

No MeSH data available.


Related in: MedlinePlus

Low midline sill sign of a patient with lumbar spondylolisthesis. Inspection of the low back to detect low midline sill sign. In this case, lumbar lordosis increases and a sill like a capital “L” is observed at the L4-5 level. The skin around the sill is wrinkled and thick compared with surrounding skin (A). Palpation of the low back to detect low midline sill sign. The examiner palpates the interspinous space and evaluates the position of the upper spinous process in relation to the lower spinous process (B).
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Fig1: Low midline sill sign of a patient with lumbar spondylolisthesis. Inspection of the low back to detect low midline sill sign. In this case, lumbar lordosis increases and a sill like a capital “L” is observed at the L4-5 level. The skin around the sill is wrinkled and thick compared with surrounding skin (A). Palpation of the low back to detect low midline sill sign. The examiner palpates the interspinous space and evaluates the position of the upper spinous process in relation to the lower spinous process (B).

Mentions: The LS detection test is composed of both inspection and palpation. The patient is asked to stand with his/her feet shoulder-width apart facing the examiner. The examiner inspects the midline of the patient’s back composed of spinous processes of lumbar and sacral spine cephalad-caudal direction. The sign is considered positive if lumbar lordosis increases and a sill like a capital “L” is inspected on the midline of the patient’s back. The skin around the sill is usually wrinkled and thick compared with the surrounding skin (Figure 1A). Following inspection, the midline of the patient’s back is then palpated. When an interspinous space is identified, the position of the upper spinous process in relation to the lower spinous process is evaluated. The sign is considered positive if the upper spinous process is displaced anterior to the lower spinous process and a sill like a capital “L” is palpated on the midline of the patient’s back. Tenderness is usually detected during palpation of the sill (Figure 1B).Figure 1


New physical examination tests for lumbar spondylolisthesis and instability: low midline sill sign and interspinous gap change during lumbar flexion-extension motion.

Ahn K, Jhun HJ - BMC Musculoskelet Disord (2015)

Low midline sill sign of a patient with lumbar spondylolisthesis. Inspection of the low back to detect low midline sill sign. In this case, lumbar lordosis increases and a sill like a capital “L” is observed at the L4-5 level. The skin around the sill is wrinkled and thick compared with surrounding skin (A). Palpation of the low back to detect low midline sill sign. The examiner palpates the interspinous space and evaluates the position of the upper spinous process in relation to the lower spinous process (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4419388&req=5

Fig1: Low midline sill sign of a patient with lumbar spondylolisthesis. Inspection of the low back to detect low midline sill sign. In this case, lumbar lordosis increases and a sill like a capital “L” is observed at the L4-5 level. The skin around the sill is wrinkled and thick compared with surrounding skin (A). Palpation of the low back to detect low midline sill sign. The examiner palpates the interspinous space and evaluates the position of the upper spinous process in relation to the lower spinous process (B).
Mentions: The LS detection test is composed of both inspection and palpation. The patient is asked to stand with his/her feet shoulder-width apart facing the examiner. The examiner inspects the midline of the patient’s back composed of spinous processes of lumbar and sacral spine cephalad-caudal direction. The sign is considered positive if lumbar lordosis increases and a sill like a capital “L” is inspected on the midline of the patient’s back. The skin around the sill is usually wrinkled and thick compared with the surrounding skin (Figure 1A). Following inspection, the midline of the patient’s back is then palpated. When an interspinous space is identified, the position of the upper spinous process in relation to the lower spinous process is evaluated. The sign is considered positive if the upper spinous process is displaced anterior to the lower spinous process and a sill like a capital “L” is palpated on the midline of the patient’s back. Tenderness is usually detected during palpation of the sill (Figure 1B).Figure 1

Bottom Line: The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively.Positive and negative predictive values of the test were 77.1% and 68.0%, respectively.The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.

View Article: PubMed Central - PubMed

Affiliation: Ahnkang Pain Free Hospital, CHA University, 323 Nonhyeon-Ro, 135-930, Kangnam-Ku, Seoul, Republic of Korea. kangahn2003@gmail.com.

ABSTRACT

Background: Lumbar spondylolisthesis (LS) and lumbar instability (LI) are common disorders in patients with low back or lumbar radicular pain. However, few physical examination tests for LS and LI have been reported. In the study described herein, new physical examination tests for LS and LI were devised and evaluated for their validity. The test for LS was designated "low midline sill sign", and that for LI was designated "interspinous gap change" during lumbar flexion-extension motion.

Methods: The validity of the low midline sill sign was evaluated in 96 patients with low back or lumbar radicular pain. Validity of the interspinous gap change during lumbar flexion-extension motion was evaluated in 73 patients with low back or lumbar radicular pain. The sensitivity, specificity, and positive and negative predictive values of the two tests were also investigated.

Results: The sensitivity and specificity of the low midline sill sign for LS were 81.3% and 89.1%, respectively. Positive and negative predictive values of the test were 78.8% and 90.5%, respectively. The sensitivity and specificity of the interspinous gap change test for LI were 82.2% and 60.7%, respectively. Positive and negative predictive values of the test were 77.1% and 68.0%, respectively.

Conclusions: The low midline sill sign and interspinous gap change tests are effective for the detection of LS and LI, and can be performed easily in an outpatient setting.

No MeSH data available.


Related in: MedlinePlus