ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study

Overview

Journal Spine (Phila Pa 1976)

Specialty Orthopedics

Date 2016 Feb 4

PMID 26839989

Citations 43

Authors

Christy Tomkins-Lane

Markus Melloh

Jon Lurie

Matt Smuck

Michele C Battie

Brian Freeman

Dino Samartzis

Richard Hu

Thomas Barz

Kent Stuber

Michael Schneider

Andrew Haig

Constantin Schizas

Jason Pui Yin Cheung

Anne F Mannion

Lukas Staub

Christine Comer

Luciana Macedo

Sang-Ho Ahn

Kazuhisa Takahashi

Danielle Sandella

Affiliations

Soon will be listed here.

Abstract

Study Design: Delphi.

Objective: The aim of this study was to obtain an expert consensus on which history factors are most important in the clinical diagnosis of lumbar spinal stenosis (LSS).

Summary Of Background Data: LSS is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.

Methods: Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An online survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.

Results: A total of 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were "leg or buttock pain while walking," "flex forward to relieve symptoms," "feel relief when using a shopping cart or bicycle," "motor or sensory disturbance while walking," "normal and symmetric foot pulses," "lower extremity weakness," and "low back pain." Significant change in certainty ceased after six questions at 80% (P < .05).

Conclusion: This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of "seven history items" that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long term may lead to more cost-effective treatment, improved health care utilization, and enhanced patient outcomes.

Level Of Evidence: 2.

Citing Articles

Development and application of predictive clinical biomarkers for low back pain care: recommendations from the ISSLS phenotype/precision spine focus group.

Hodges P, Sowa G, ONeill C, Vo N, Foster N, Samartzis D Eur Spine J. 2025; .

PMID: 39964488 DOI: 10.1007/s00586-025-08720-4.

Identifying modifiable factors that influence walking in patients undergoing surgery for neurogenic claudication: a prospective longitudinal study.

McIlroy S, Bearne L, Weinman J, Norton S Sci Rep. 2025; 15(1):4959.

PMID: 39929935 PMC: 11811296. DOI: 10.1038/s41598-025-87894-9.

Surgical interventions for degenerative lumbar spinal stenosis: a systematic review with network meta-analysis.

Chen L, Guan B, Anderson D, Ferreira P, Stanford R, Beckenkamp P BMC Med. 2024; 22(1):430.

PMID: 39379938 PMC: 11463109. DOI: 10.1186/s12916-024-03653-z.

Intraoperative changes of surgical approach and a second surgery after percutaneous endoscopic surgery for lumbar spinal stenosis.

Lu L, Yuan Z, Li H, Sun S Clinics (Sao Paulo). 2024; 79:100498.

PMID: 39342667 PMC: 11465208. DOI: 10.1016/j.clinsp.2024.100498.

Functional Outcomes of Therapeutic Selective Nerve Root Block for Single-Segment Lumbar Spinal Stenosis: A Retrospective Study.

Xiao S, Zhu S, Guan B, Zhao J Med Sci Monit. 2024; 30:e943634.

PMID: 38905165 PMC: 11305107. DOI: 10.12659/MSM.943634.

References

Benoist M . The natural history of lumbar degenerative spinal stenosis. Joint Bone Spine. 2002; 69(5):450-7. DOI: 10.1016/s1297-319x(02)00429-3. View

Harrop J, Hilibrand A, Mihalovich K, Dettori J, Chapman J . Cost-effectiveness of surgical treatment for degenerative spondylolisthesis and spinal stenosis. Spine (Phila Pa 1976). 2014; 39(22 Suppl 1):S75-85. DOI: 10.1097/BRS.0000000000000545. View

Sandella D, Haig A, Tomkins-Lane C, Yamakawa K . Defining the clinical syndrome of lumbar spinal stenosis: a recursive specialist survey process. PM R. 2012; 5(6):491-5. DOI: 10.1016/j.pmrj.2012.10.001. View

Konstantinou K, Hider S, Vogel S, Beardmore R, Somerville S . Development of an assessment schedule for patients with low back-associated leg pain in primary care: a Delphi consensus study. Eur Spine J. 2011; 21(7):1241-9. PMC: 3389105. DOI: 10.1007/s00586-011-2057-2. View

Konno S, Hayashino Y, Fukuhara S, Kikuchi S, Kaneda K, Seichi A . Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J. 2007; 16(11):1951-7. PMC: 2223350. DOI: 10.1007/s00586-007-0402-2. View

Ammendolia C, Stuber K, Rok E, Rampersaud R, Kennedy C, Pennick V . Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013; (8):CD010712. PMC: 11787928. DOI: 10.1002/14651858.CD010712. View

Kalichman L, Cole R, Kim D, Li L, Suri P, Guermazi A . Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009; 9(7):545-50. PMC: 3775665. DOI: 10.1016/j.spinee.2009.03.005. View

Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S . Predictive value of self-reported patient information for the identification of lumbar spinal stenosis. Fam Pract. 2008; 25(4):237-44. DOI: 10.1093/fampra/cmn031. View

Arbit E, Pannullo S . Lumbar stenosis: a clinical review. Clin Orthop Relat Res. 2001; (384):137-43. View

10.

Chad D . Lumbar spinal stenosis. Neurol Clin. 2007; 25(2):407-18. DOI: 10.1016/j.ncl.2007.01.003. View

11.

Haig A, Park P, Henke P, Yamakawa K, Tomkins-Lane C, Valdivia J . Reliability of the clinical examination in the diagnosis of neurogenic versus vascular claudication. Spine J. 2013; 13(12):1826-34. PMC: 3858492. DOI: 10.1016/j.spinee.2013.06.021. View

12.

Tosteson A, Lurie J, Tosteson T, Skinner J, Herkowitz H, Albert T . Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med. 2008; 149(12):845-53. PMC: 2658642. DOI: 10.7326/0003-4819-149-12-200812160-00003. View

13.

Watters 3rd W, Baisden J, Gilbert T, Kreiner S, Resnick D, Bono C . Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2007; 8(2):305-10. DOI: 10.1016/j.spinee.2007.10.033. View

14.

Haskins R, Osmotherly P, Rivett D . Diagnostic clinical prediction rules for specific subtypes of low back pain: a systematic review. J Orthop Sports Phys Ther. 2015; 45(2):61-76, A1-4. DOI: 10.2519/jospt.2015.5723. View

15.

Chan A, Ford J, McMeeken J, Wilde V . Preliminary evidence for the features of non-reducible discogenic low back pain: survey of an international physiotherapy expert panel with the Delphi technique. Physiotherapy. 2013; 99(3):212-20. DOI: 10.1016/j.physio.2012.09.007. View

16.

Ammendolia C, Stuber K, de Bruin L, Furlan A, Kennedy C, Rampersaud Y . Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine (Phila Pa 1976). 2011; 37(10):E609-16. DOI: 10.1097/BRS.0b013e318240d57d. View

17.

Zaina F, Tomkins-Lane C, Carragee E, Negrini S . Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016; (1):CD010264. PMC: 6669253. DOI: 10.1002/14651858.CD010264.pub2. View

18.

Lin S, Lin R . Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance. J Orthop Sports Phys Ther. 2005; 35(4):220-6. DOI: 10.2519/jospt.2005.35.4.220. View

19.

Conway J, Tomkins C, Haig A . Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures. Spine J. 2010; 11(9):816-23. PMC: 3136653. DOI: 10.1016/j.spinee.2010.10.019. View

20.

Katz J, Dalgas M, Stucki G, Lipson S . Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am. 1994; 20(2):471-83. View