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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

Principle of the interspinous gap change test. During flexion of the lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra. “a” distance between the upper and lower spinous processes in supero-inferior direction in a flexion state; “b” distance between the upper and lower spinous processes in antero-posterior direction in a flexion state (A). During extension of the lumbar spine, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra. “a*” distance between the upper and lower spinous processes in supero-inferior direction in an extension state; “b*” distance between the upper and lower spinous processes in antero-posterior direction in an extension state (B).
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Fig4: Principle of the interspinous gap change test. During flexion of the lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra. “a” distance between the upper and lower spinous processes in supero-inferior direction in a flexion state; “b” distance between the upper and lower spinous processes in antero-posterior direction in a flexion state (A). During extension of the lumbar spine, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra. “a*” distance between the upper and lower spinous processes in supero-inferior direction in an extension state; “b*” distance between the upper and lower spinous processes in antero-posterior direction in an extension state (B).

Mentions: Detection of a movement abnormality with passive intervertebral motion has been proposed for the detection of LI. Abbott et al. [14] performed a passive accessory intervertebral motion test and passive physiological intervertebral motion test in prone or side-lying position, and reported that the two tests are highly specific, but not sensitive. However, the interspinous gap change test is performed in an erect position, which imitates the positioning of lumbar lateral flexion-extension radiographs. Figure 4 shows the principle of the interspinous gap change test. If a patient with LI flexes his/her lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra (Figure 4A). If the patient extends, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra (Figure 4B). Therefore, the examiner detects a position change of the upper and lower spinous processes in supero-inferior and antero-posterior direction during lumbar flexion-extension motion, which is the principle of the interspinous gap change test.Figure 4


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)

Principle of the interspinous gap change test. During flexion of the lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra. “a” distance between the upper and lower spinous processes in supero-inferior direction in a flexion state; “b” distance between the upper and lower spinous processes in antero-posterior direction in a flexion state (A). During extension of the lumbar spine, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra. “a*” distance between the upper and lower spinous processes in supero-inferior direction in an extension state; “b*” distance between the upper and lower spinous processes in antero-posterior direction in an extension state (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Principle of the interspinous gap change test. During flexion of the lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra. “a” distance between the upper and lower spinous processes in supero-inferior direction in a flexion state; “b” distance between the upper and lower spinous processes in antero-posterior direction in a flexion state (A). During extension of the lumbar spine, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra. “a*” distance between the upper and lower spinous processes in supero-inferior direction in an extension state; “b*” distance between the upper and lower spinous processes in antero-posterior direction in an extension state (B).
Mentions: Detection of a movement abnormality with passive intervertebral motion has been proposed for the detection of LI. Abbott et al. [14] performed a passive accessory intervertebral motion test and passive physiological intervertebral motion test in prone or side-lying position, and reported that the two tests are highly specific, but not sensitive. However, the interspinous gap change test is performed in an erect position, which imitates the positioning of lumbar lateral flexion-extension radiographs. Figure 4 shows the principle of the interspinous gap change test. If a patient with LI flexes his/her lumbar spine, the spinous process of the upper vertebra is translated superiorly and anteriorly in relation to the spinous process of the lower vertebra (Figure 4A). If the patient extends, the spinous process of the upper vertebra is translated inferiorly and posteriorly in relation to the spinous process of the lower vertebra (Figure 4B). Therefore, the examiner detects a position change of the upper and lower spinous processes in supero-inferior and antero-posterior direction during lumbar flexion-extension motion, which is the principle of the interspinous gap change test.Figure 4

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