Of the 19 patient history data variables assessed, three had sensitivity values greater than 80 percent: “pain worse with sitting” (sensitivity=85 percent), “wake up from sleep due to pain” (sensitivity=81 percent) and “pain worse with walking” (sensitivity=80 percent). 5 While tests such as hamstring contraction, lumbar extension, double leg raise and loss of ankle and great toe extension strength had high specificity values (ranging 80 to 100 percent) all of the aforementioned tests had low sensitivity values and therefore aren’t considered reliable in the diagnosis of spondylolysis in young patients with LBP. Other clinical findings evaluated were hamstring contraction, lumbar range of motion (ROM), single leg raise, double leg raise, femoral nerve stretch, Achilles and patellar reflexes and loss of ankle and great toe extension strength. 5 However, the authors discussed the sensitivity and specificity values were not high enough to consider this test reliable in clinically diagnosing spondylolysis. Of the 34 clinical tests, 1,5 single leg hyperextension was documented to have the highest sensitivity (50 to 73 percent) and specificity (zero to 87 percent) in diagnosing spondylolysis. 5 Sudden onset of symptoms (sensitivity=88 percent, specificity=51 percent) and sports participation (sensitivity=85 percent, specificity=34 percent) had the highest diagnostic value for spondylolysis. Age at evaluation, gender, duration of symptoms less than three months, sudden onset of symptoms and participation in sport were assessed. The 2016 systematic review 5 identified five patient data history variables used to diagnose spondylolysis. 2,4,6 However, concerns related to ionizing radiation exposure for young patients warrants discussion of the diagnostic accuracy of an alternative imaging techniques. 2,6,7 CT is currently the gold standard for diagnosing defects of the pars interarticularis. A 2016 review 5 is an update of a similar systemic review 1 published in 2014 with the addition of two clinical tests, the evaluation of patient history data and narrowed inclusion criteria to studies investigating athletes younger than 20 years of age suffering LBP.Īdditionally, three systematic reviews were found investigating the diagnostic value of magnetic resonance imaging in diagnosing spondylolysis and spondylolisthesis. In patients with LBP, which exam findings are the most accurate in diagnosing lumbar spondylolysis and spondylolisthesis?Ī literature search of Medline, CINHAL and SportDiscus returned two systematic reviews 1,5 that investigated diagnostic accuracy of subjective and objective exam findings in the clinical diagnosis of spondylolysis and spondylolisthesis. However, clinicians should be aware of the accuracy and clinical utility of special tests and patient history data in guiding clinical decision-making in patients with LBP suspected of suffering spondylolysis or spondylolisthesis. 3 Commonly patient history data, the standing stork test and spring test are used to diagnose. Symptoms of pars interarticularis defects are similar to other lumbar pathologies causing challenges in determining whether advanced imaging techniques are warranted. 4 Therefore, the utilization of accurate clinical tests is crucial when determining whether advanced imaging is warranted in patients suspected of a spondylolysis. Computed tomography (CT) is considered the gold standard for assessing body defects of the pars interarticularis but exposes the patient to high levels of radiation and can be costly to patients. 3 Accurate diagnosis is crucial in initiating proper treatment for spondylolysis to prevent progression to spondylolisthesis and increased risk of dysfunction. If left untreated, spondylolysis can progress to a bilateral pars interarticularis defect known as spondylolisthesis, which can lead to an increased risk of dysfunction and inability to participate in sport. 1,2 This leads many authors to believe the condition is often underdiagnosed. 1 Additionally, there are few preclinical indications unique to spondylosis. It has been estimated that 63 percent of individuals participating in sports will suffer a spondylolysis and 6 to 8 percent of individuals suffering low back pain (LBP) are diagnosed with a spondylolithesis.
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