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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 51

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 51. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 488 Section Degenerative Disorders A positive Lasegue sign with radicular pain is indicative of a radiculopathy The neurologic examination is often diagnostic Symptomatic thoracic disc herniation presents with signsofa myelopathy Testing of the Lasegue sign straight leg raising is crucial for the diagnosis of a radiculopathy see Chapter 8 . The definition of a Lasegue test is largely variable in the literature 120 128 . Most articles do not determine radicular pain as a criterion for a positive Lasegue test. We define the Lasegue sign based on the original publication as positive if the patient reports radicular leg pain while raising the ipsilateral straight leg. Radicular pain must be differentiated from non-radicular leg pain which is frequent and often related to tight hamstrings. The key feature is the occurrence of radicular leg pain which is pathologic regardless of whether it occurs at 10 or 70 degrees of hip flexion. The positive contralateral straight-leg raising test is most specific for disc herniation indicating a large herniation ranging to the contralateral side. The reverse straight leg raising test or femoral stretch test causes root tension at L2 L3 and L4 see Chapter 8 . A positive ipsilateral straight leg raising test is a sensitive 72 - 97 but less specific finding 11-66 . However the results are critically dependent on the definition of the test. The criterion of radicular leg pain substantially increases the diagnostic accuracy. In contrast a positive crossed straight leg raising test is less sensitive 23 - 42 but much more specific 85 -100 6 . In children and adolescents key findings are 135 157 tight hamstrings and severely restricted spinal motion Beside the neurologic findings the physical assessment see Chapter 8 in patients with disc herniation is less diagnostic. In patients with thoracic disc herniations the physical findings are subtle unless the patients present with an obvious paraparesis or paraplegia. However a careful .