Spengler et al developed an Objective Evaluation System for evaluating patients with a possible herniated lumbar disc. This can help to identify a patient prior to surgery who will benefit from lumbar discectomy. The authors are from the University of Washington in Seattle and the Seattle Veterans Administration Hospital.
Parameters:
(1) neurological signs
(2) sciatic tension signs
(3) personality factors (based on MMPI)
(4) imaging studies (lumbar myelography, CT or MRI)
|
Neurological Signs |
Findings |
Points |
|
weakness consistent with level of lesion |
with positive EMG |
25 |
|
|
with negative EMG |
10 |
|
|
none |
0 |
|
atrophy (more than 2 cm) |
absent |
0 |
|
|
present |
10 |
|
reflexes |
absent or asymmetrical, age <= 50 years, positive EMG |
25 |
|
|
absent or asymmetrical, age <= 50 years, negative EMG |
20 |
|
|
absent or asymmetrical, age > 50, positive EMG |
25 |
|
|
absent or asymmetrical, age > 50, negative EMG |
10 |
|
|
normal |
0 |
|
no clinical signs |
EMG positive |
15 |
|
|
EMG negative |
0 |
where:
• Atrophy would be measured by limb circumference, reflecting muscle mass.
|
Sciatic Tension |
Points |
|
crossed straight leg raising test positive |
20 |
|
pelvic tilt |
15 |
|
dysrhythmia of lumbar paraspinal muscles when back is in motion |
15 |
|
ipsilateral straight leg raising test positive |
5 |
|
all absent |
0 |
where:
• A positive crossed straight leg raising test involves pain in the asymptomatic side when the leg on the asymptomatic side is raised..
|
Personality Factors |
Points |
|
normal |
25 |
|
depression |
25 |
|
impulsive or schizophrenic |
10 |
|
hypochondriasis |
10 |
|
hysteria (above 1 SD but less than 2 SD above mean) |
10 |
|
hysteria (>= mean + 2 SD) |
0 |
|
conversion reaction |
0 |
|
Imaging Studies |
Points |
|
normal |
0 |
|
positive but does not match clinical findings |
0 |
|
equivocal nerve root asymmetry |
10 |
|
positive and matches clinical findings |
25 |
objective evaluation score =
= MIN(25, total for neurological signs) + MIN(25, total for sciatic tension signs) + MIN(25, total for personality factors) + MIN(25, imaging studies)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the more likely that the patient will have a good result following discectomy.
Specialty: Surgery, orthopedic
ICD-10: ,
