Annemieke J.H. Verwoerd, MD, MSc

The Spine Journal
Available online 8 December 2013 In Press

Abstract
Background Context
The diagnosis of sciatica is primarily based on history and physical examination. Most physical tests used in isolation show poor diagnostic accuracy. Little is known about the diagnostic accuracy of history items.

Purpose
To assess the diagnostic accuracy of history taking for the presence of lumbosacral nerve root compression or disc herniation on MRI in patients with sciatica.

Study Design
Cross-sectional diagnostic study.

Patient Sample
A total of 395 adult patients with severe disabling radicular leg pain of 6-12 weeks duration were included.

Outcome measures
Lumbosacral nerve root compression and disc herniation on MRI were independently assessed by two neuroradiologists and one neurosurgeon blinded to any clinical information.

Methods
Data were prospectively collected in 9 hospitals. History was taken according to a standardized protocol. There were no study-specific conflicts of interest.

Results
Exploring the diagnostic odds ratio of 20 history items revealed a significant contribution in diagnosing nerve root compression for ‘male sex’, ‘pain worse in leg than in back’ and ‘a non-sudden onset’. A significant contribution to the diagnosis of a herniated disc was found for ‘BMI <30’, ‘a non-sudden onset’, and ‘sensory loss’. Multivariate logistic regression analysis of 6 history items pre-selected from the literature (age, gender, pain worse in leg than in back, sensory loss, muscle weakness and more pain on coughing/sneezing/straining) revealed an AUC of 0.65 (95%CI 0.58-0.71) for the model diagnosing nerve root compression and an AUC of 0.66 (95%CI 0.58-0.74) for the model diagnosing disc herniation.

Conclusions
A few history items used in isolation had significant diagnostic value and the diagnostic accuracy of a model with 6 pre-selected items was poor.