腰部脊柱管狭窄症のスクリーニング精度
Diagnostic Screening for Lumbar Spinal Stenosis
正確な罹患率は不明だが、多いと予測される腰部脊柱管狭窄症(LSS)；診断基準にもよるが、60歳以上の18-49%の範囲。
これまでにいくつかの質問票が作成されてきた
しかし慢性腰痛や下肢症状からLSSを導くものはない。
質問票は5編の先行研究で報告されたものの41項目から、重複質問などは省いた13項目となった。
Table A provides a list of all relevant questions or symptoms extracted from the five papers.
QUESTIONS OR SYMPTOMS IDENTIFIED IN RELEVANT LITERATURE (41 ITEMS)
Q1 Numbness and/or pain in the thighs down to the calves and shins.
Q2 Numbness and/or pain increase in intensity after walking for a while but are
relieved by taking a rest.
Q3 Standing for a while brings on numbness and/or pain in the thighs down to the
calves and shins.
Q4 Numbness and/or pain are reduced by bending forwards.
Q5 Numbness is present in both legs.
Q6 Numbness is present in the soles of both feet.
Q7 Numbness arises around the buttocks.
Q8 Numbness is present but pain is absent.
Q9 A burning sensation arises around the buttocks.
Q10 Walking nearly causes urination.
Q11 Difficulty bending forward because of numbness and/or pain.
Q12 Difficulty putting on socks because of numbness and/or pain.
Q13 Numbness and/or pain increase in intensity after walking for a while but are
relieved by taking a rest.
Q14 Standing for a while brings numbness and/or pain in the thigh(s) down to the
calf or calves and shin(s).
Q15 Numbness and/or pain are reduced by bending forward.
Q16 Numbness is present, but pain is absent.
Q17 Numbness and/or pain is present in both legs.
Q18 Numbness is present in the soles of both feet.
Q19 Numbness arises around the buttocks.
Q20 I am ≥ 60 years old.
Q21 Does the patient have leg or buttock pain while walking?
Q22 Does the patient flex forward to relieve symptoms?
Q23 Does the patient feel relief when using a shopping cart or bicycle?
Q24 Does the patient have motor or sensory disturbance while walking?
Q25 Are the pulses in the foot present and symmetric?
Q26 Does the patient have lower extremity weakness?
Q27 Does the patient have low back pain?
Sandella et al.4 Q28 Leg pain while walking
Q29 Must sit down or bend forward to relieve pain
Q30 Flex forward while walking
Q31 Normal pulses in foot
Q32 Low back pain
Q33 Lower extremity weakness
Q34 Relief with rest
Q35 Sensory deficit
Q36 Age >60 years
Q37 Positive 30-s extension test
Q38 Patient reports pain in both legs
Q39 Patient reports leg pain relieved by sitting
Q40 Patient reports leg pain decreased by leaning forward or flexing the spine
Q41 Negative SLR-60 test
対象は153名のLSS患者と230名の健常人となった。
今回の13質問票では、
AUC；0.72
特異度；20%
感度95%
となった。
今回の質問票では、LSSに対しての有効性は低いかもしれません。
しかし感度は高いので除外には使えるかもしれない。
今回の検討は症例対照試験なので、エビデンスレベルは低いが、こうしたものが開発され、有用性が調査されると、鍼灸院としては助かると思います。
