Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy
Date
2019-05-30
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Lumbo-sacral radiculopathy (LSR) is a common musculoskeletal disorder for which patients seek
medical care and referrals for advanced imaging. However, accurate diagnosis remains challenging. Neuropathic
pain screening questionnaires, clinical neurological examination and magnetic resonance imaging (MRI) are used in
the initial diagnosis. The utility of these tools in diagnosing LSR varies and their correlation has not been reported.
Methods: A cross-sectional, multicentre, blinded design was used in six physiotherapy departments in Kenya. Each
participant was blindly examined by three independent clinicians using the Self-Reported Leeds Assessment of
Neuropathic Symptoms and Signs (S-LANSS) score, clinical neurological examination (CNE) and MRI. Spearman’s
rank coefficient (r) was used to examine the correlation between the three tests. Linear regression and odds ratios
were used to establish correlations between socio-demographic, clinical and diagnostic parameters. The diagnostic
accuracy of individual or combined sets of CNE tests in diagnosing LSR, with reference to MRI, was determined
using Receiver Operating Characteristics (ROC) curves.
Results: We enrolled 102 participants (44 males, 58 females; mean age: 44.7 years). Results indicated a significant
positive correlation (r = 0.36, P = 0.01) between S-LANSS, CNE and MRI among patients with low back and radiating
leg symptoms. Positive agreement existed between combined neuro-conduction tests (sensory, motor and reflex)
and neuro-dynamic tests (NDT).
The NDT component of CNE (Straight Leg Raise Test [SLRT] and Femoral Nerve Stretch Test [FNST]) was significantly
associated (P = 0.05) with MRI: patients who had positive NDT results had higher odds (8.3) for positive nerve root
compromise on MRI versus those who had negative NDT results.
Conclusion: This was the first study to investigate the correlation between S-LANSS, CNE and MRI in patients presenting with
low back and radiating leg symptoms. Results indicated a significant positive correlation. The strongest correlations to MRI
findings of LSR were firstly, NDT (SLRT and FNST); secondly, the S-LANSS score; and thirdly, the CNE components of motor
power and deep tendon reflex. The clinical implication is that clinicians can confidently use the S-LANSS score and CNE to
diagnose and make therapeutic decisions in LSR, when MRI is medically contra-indicated, unaffordable or unavailable.
Description
CITATION: Tawa, N., et al. 2019. Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy. BMC Neurology, 19:107, doi:10.1186/s12883-019-1333-3.
The original publication is available at https://bmcneurol.biomedcentral.com
The original publication is available at https://bmcneurol.biomedcentral.com
Keywords
Lumbar vertebrae -- Diagnostic imaging, Lumbar vertebrae -- Magnetic resonance imaging, Spinal nerve roots -- Radiography, Neurologic examination, Lumbosacral region -- Diagnostic imaging
Citation
Tawa, N., et al. 2019. Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy. BMC Neurology, 19:107, doi:10.1186/s12883-019-1333-3