Graver et al used the Clinical Overall Score (COS) to evaluate patients with low back pain who underwent lumbar disc surgery. The authors are from Ulleval University Hospital in Oslo and Unversity of Bergen in Norway.
Parameters:
(1) pain intensity for low back and/or leg
(2) physical signs (spinal deviation, Lasegue’s test, muscle atrophy, muscle strength, sensory impairment to pinprick)
(3) functional capacity by Oswestry low back pain disability score
(4) analgesics
|
Parameter |
Finding |
Points |
|
back pain |
VAS scale 0 (none) to 100 mm (worst imaginable) |
VAS |
|
leg pain |
VAS scale 0 (none) to 100 mm (worst imaginable) |
VAS |
|
spinal deviation in an upright or flexed position |
no abnormality |
0 |
|
|
indeterminate or mild change |
10 |
|
|
clear cut abnormality |
20 |
|
Lasegue’s test |
negative |
0 |
|
|
positive at > 60 degrees |
0 |
|
|
positive 30 to 60 degrees |
10 |
|
|
positive at < 30 degrees |
20 |
|
muscle atrophy |
no abnormality |
0 |
|
|
indeterminate or mild change |
10 |
|
|
clear cut abnormality |
20 |
|
muscle strength |
no abnormality |
0 |
|
|
indeterminate or mild change |
10 |
|
|
clear cut abnormality |
20 |
|
sensory impairment to pinprick |
no abnormality |
0 |
|
|
indeterminate or mild change |
10 |
|
|
clear cut abnormality |
20 |
|
functional impairment |
0 to 100 percent |
percent |
|
analgesics |
none |
0 |
|
|
occasional or modest doses of non-narcotic drug (ASA, acetaminophen, NSAID) |
20 |
|
|
above plus codeine or similar drug and/or muscle relaxant |
40 |
|
|
regular doses of analgesic plus codeine or similar drug and/or a tranquilizer |
60 |
|
|
high doses of analgesic plus codeine or similar drug and hypnotic; intermittent or low dose opioid therapy |
80 |
|
|
high and regular doses of opioids (maximal) |
100 |
where:
• The Oswestry score consists of 10 items rated from 0 to 5 points, giving a score that ranges from 0 to 50.
COS =
= (4 * (MAX(low back pain, leg pain)) + (2 * SUM(points for physical signs)) + (2 * (functional capacity)) + (2 * (analgesics))
Interpretation:
• minimum score: 0
• maximum score: 1,000
• The higher the score the more worse the outcome.
Specialty: Surgery, orthopedic
ICD-10: ,
