BACKGROUND AND AIM: The Oswestry Disability Index (ODI) is an interview-based instrument generally accepted as a measure of disability in patients with lumbar spinal stenosis (LSS). There is, however, no generally accepted measure for neurological impairment in LSS. We therefore developed a scoring system [neurological impairment score in lumbar spinal stenosis (NIS-LSS)] for the assessment of neurological impairment in the lower limbs of patients with LSS, then performed a validation study to facilitate its implementation in the routine clinical evaluation of patients with LSS. METHODS: The NIS-LSS is based on the combined evaluation of tendon reflexes, tactile and vibratory sensation, pareses, and the ability to walk and run; the total score ranges from 0 (inability to walk) to 33 points (no impairment). A group of 117 patients with LSS and a control group of 63 age- and sex-matched healthy volunteers were assessed with the NIS-LSS to evaluate capacity to discriminate between LSS patients and controls. A correlation with the ODI was performed for assessment of construct validity. RESULTS: The median NIS-LSS was 27 points in LSS patients compared with 33 points in controls. The NIS-LSS discriminated LSS patients from healthy controls to a high degree of significance: the optimum NIS-LSS cut-off value was 32 points with a sensitivity of 85.5% and a specificity of 81.3% (p < 0.001). Overall NIS-LSS correlated significantly with the ODI score (p < 0.001). Vibratory sensation (p = 0.04), presence of paresis (p = 0.01) and especially the ability to walk and run (p < 0.001) were the NIS-LSS elements that correlated most closely with the degree of disability assessed by the ODI. CONCLUSIONS: The NIS-LSS is a simple and valid measure of neurological impairment in the lower limbs of patients with LSS (without comorbidity), discriminating them from healthy controls to a high degree of sensitivity and specificity and correlating closely with the degree of disability. It extends our ability to quantify neurological status and to follow changes arising out of the natural course of the disease or the effects of treatment.

Department of Neurology University Hospital and Masaryk University Brno Jihlavska 20 62500 Brno Czech Republic

Zobrazit více v PubMed

Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil. 1998;79:700–708. doi: 10.1016/S0003-9993(98)90048-X. PubMed DOI

Vohanka S, Adamova B (2003) Lumbar spinal stenosis (in Czech). In: Group of authors. Neurology. Triton, Prague, pp 160–180

Stucki G, Liang MH, Lipson SJ, Fossel AH, Katz JN. Contribution of neuromuscular impairment to physical functional status in patients with lumbar spinal stenosis. J Rheumatol. 1994;21:1338–1343. PubMed

Bergner M, Bobbitt RA, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care. 1981;19:787–805. doi: 10.1097/00005650-198108000-00001. PubMed DOI

Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483. doi: 10.1097/00005650-199206000-00002. PubMed DOI

Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–273. PubMed

Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141–144. doi: 10.1097/00007632-198303000-00004. PubMed DOI

Hagg O, Fritzell P, Romberg K, Nordwall A. The general function score: a useful tool for measurement of physical disability. Validity and reliability. Eur Spine J. 2001;10:203–210. doi: 10.1007/s005860000221. PubMed DOI PMC

Kopec JA, Esdaile JM. Functional disability scales for back pain. Spine. 1995;20:1943–1949. doi: 10.1097/00007632-199509000-00021. PubMed DOI

Waddell G, Main CJ. Assessment of severity in low-back disorders. Spine. 1984;9:204–208. doi: 10.1097/00007632-198403000-00012. PubMed DOI

Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine. 1996;21:796–803. doi: 10.1097/00007632-199604010-00004. PubMed DOI

Lassale B, Bitan F, Bex M, Deburge A. Functional results and prognostic factors in the surgical treatment of degenerative lumbar stenosis (in French) Rev Chir Orthop Reparatrice Appar Mot. 1988;74(Suppl 2):85–88. PubMed

Makan P, Fairbank J, Wanders L. Clinical assessment of lumbar spinal stenosis. J Bone Joint Surg. 1998;30:SII158.

Roland M, Fairbank J. The Roland–Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000;25:3115–3124. doi: 10.1097/00007632-200012150-00006. PubMed DOI

Baker D, Pynsent P, Fairbank J. The Oswestry disability index revisited. In: Roland J, Jenner J, editors. Back pain: new approaches to rehabilitation and education. Manchester: Manchester University Press; 1989. pp. 174–186.

Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25:2940–2953. doi: 10.1097/00007632-200011150-00017. PubMed DOI

Okoro T, Qureshi A, Sell B, Sell P. The accuracy of assessment of walking distance in the elective spinal outpatients setting. Eur Spine J. 2010;19:279–282. doi: 10.1007/s00586-009-1152-0. PubMed DOI PMC

Schulte TL, Schubert T, Winter C, Brandes M, Hackenberg L, Wassmann H, Liem D, Rosenbaum D, Bullmann V. Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery. Eur Spine J. 2010;19:1855–1864. doi: 10.1007/s00586-010-1324-y. PubMed DOI PMC

Claus D, Carvalho VP, Neundörfer B, Blaise JF. Perception of vibration. Normal findings and methodologic aspects (in German) Nervenarzt. 1988;59:138–142. PubMed

Martina IS, van Koningsveld R, Schmitz PI, van der Meché FG, van Doorn PA. Measuring vibration threshold with a graduated tuning fork in normal aging and in patients with polyneuropathy. J Neurol Neurosurg Psychiatry. 1998;65:743–747. doi: 10.1136/jnnp.65.5.743. PubMed DOI PMC

Micankova Adamova B, Vohanka S, Dusek L, Jarkovsky J, Bednarik J. Prediction of long-term clinical outcome in patients with lumbar spinal stenosis. Eur Spine J. 2012;21:2611–2619. doi: 10.1007/s00586-012-2424-7. PubMed DOI PMC

Denda H, Kimura S, Yamazaki A, Hosaka N, Takano Y, Imura K, Yajiri Y, Endo N. Clinical significance of cerebrospinal fluid nitric oxide concentrations in degenerative cervical and lumbar diseases. Eur Spine J. 2011;20:604–611. doi: 10.1007/s00586-010-1663-8. PubMed DOI PMC

Inoue S, Kataoka O, Tajima T. Assessment of treatment for low back pain. J Japanese Orthop Assoc. 1986;60:909–911.

Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine. 1992;17:1–8. doi: 10.1097/00007632-199201000-00001. PubMed DOI

Vohanka S, Adamova B, Dusek L. Clinical manifestations of lumbar spinal stenosis. Eur J Neurol. 2005;12(Suppl 2):154.

Outcomes and their predictors in lumbar spinal stenosis: a 12-year follow-up