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THE RATIONAL CLINICIAN’S CORNER CLINICAL EXAMINATION Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis? Pradeep Suri, MD Context The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagno- James Rainville, MD sis in older adults presenting with lower extremity pain. Leonid Kalichman, PT, PhD Objective To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. Jeffrey N. Katz, MD, MS Data Sources MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. CLINICAL SCENARIO Study Selection Studies were included if they contained adequate data on the accu- In the following cases, the clinician racy of the history and physical examination for diagnosing the clinical syndrome of LSS, would like to know if the patient has using a reference standard of expert opinion with radiographic or anatomic confirmation. the clinical syndrome of lumbar spi- Data Extraction Two authors independently reviewed each study to determine eli- nal stenosis (LSS). gibility, extract data, and appraise levels of evidence. Case 1 Data Synthesis Four studies evaluating 741 patients were identified. Among pa- tients with lower extremity pain, the likelihood of the
JAMA – American Medical Association
Published: Dec 15, 2010
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