Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Spine (Phila Pa 1976). 2013 Apr 15;38(8):E469-81. doi: 10.1097/BRS.0b013e31828935ac.
Systematic review of diagnostic studies.
To update our previous systematic review on the diagnostic accuracy of tests used to diagnose lumbar spinal stenosis.
A wide range of clinical, radiological, and electrodiagnostic tests are used to diagnose lumbar spinal stenosis. An accurate diagnosis is vital, because lumbar spinal stenosis may require specific medical advice and treatment. Therefore, it is important to know the accuracy of these diagnostic tests currently available.
A comprehensive literature search was conducted for original diagnostic studies on lumbar spinal stenosis, in which one or more diagnostic tests were evaluated with a reference standard, and diagnostic accuracy was reported or could be calculated. Our previous systematic review included studies up to March 2004; this review is current up to March 2011. Included studies were assessed for their methodological quality using the QUADAS tool. Study characteristics and reported diagnostic accuracy were extracted.
Twenty-two additional articles in addition to the 24 included in the previous review met the inclusion criteria. Combined, this resulted in 20 articles concerning imaging tests, 11 articles evaluating electrodiagnostic tests, and 15 articles evaluating clinical tests. Estimates of the diagnostic accuracy of the tests differed considerably.
There is a need for a consensus on criteria to define and classify lumbar spinal stenosis. At present, the most promising imaging test for lumbar spinal stenosis is magnetic resonance imaging, avoiding myelography because of its invasiveness and lack of superior accuracy. Electrodiagnostic studies showed no superior accuracy for conventional electrodiagnostic testing compared with magnetic resonance imaging. These tests should be considered in the context of those presenting symptoms with the highest diagnostic value, including radiating leg pain that is exacerbated while standing up, the absence of pain when seated, the improvement of symptoms when bending forward, and a wide-based gait.
系统评价诊断研究。
更新我们之前关于用于诊断腰椎椎管狭窄症的测试的诊断准确性的系统评价。
广泛使用临床、放射学和电诊断测试来诊断腰椎椎管狭窄症。准确的诊断至关重要，因为腰椎椎管狭窄症可能需要特定的医疗建议和治疗。因此，了解目前可用的这些诊断测试的准确性非常重要。
对原始诊断研究进行了全面的文献搜索，这些研究中评估了一种或多种诊断测试，并使用参考标准报告或可以计算诊断准确性。我们之前的系统评价包括截至 2004 年 3 月的研究；本次审查截至 2011 年 3 月。使用 QUADAS 工具评估纳入研究的方法学质量。提取研究特征和报告的诊断准确性。
除之前综述中包含的 24 篇文章外，还有 22 篇额外的文章符合纳入标准。综合起来，这导致 20 篇关于影像学检查的文章，11 篇评估电诊断检查的文章，和 15 篇评估临床检查的文章。测试的诊断准确性估计差异很大。
需要就定义和分类腰椎椎管狭窄症的标准达成共识。目前，对于腰椎椎管狭窄症最有前途的影像学检查是磁共振成像，避免因侵入性和缺乏更高准确性而进行脊髓造影。与磁共振成像相比，常规电诊断测试的电诊断研究显示出没有更高的准确性。这些测试应根据那些具有最高诊断价值的症状进行考虑，包括放射状腿部疼痛在站立时加剧，坐着时没有疼痛，向前弯曲时症状改善，以及宽基步态。
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