title: Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests.
abstract: METHODS
  Systematic review of diagnostic studies.
  
  
  OBJECTIVE
  To investigate the diagnostic performance of tests used to detect lumbar spinal stenosis.
  
  
  BACKGROUND
  Little is known about the diagnostic accuracy of tests in detecting lumbar spinal stenosis. A systematic review will provide more insight in this topic.
  
  
  METHODS
  We performed a literature search in Medline (PubMed) and Embase for original diagnostic studies on lumbar spinal stenosis, in which one or more different tests were evaluated with a reference standard, and diagnostic values were reported or could be calculated. Two reviewers independently checked all abstracts and full text articles for inclusion criteria. Included articles were assessed for their quality using the Quadas tool. Study features and diagnostic values were extracted from the included studies.
  
  
  RESULTS
  Of the 24 articles included in this review, 15 concerned imaging tests, 7 evaluated "clinical tests," and 2 reported on other diagnostic tests. The overall quality was poor; only 5 studies scored positive on more than 50% of the quality items. Estimates of the diagnostic value of the tests differed considerably. The imaging studies showed no superior accuracy for myelography compared with CT or MRI. Overall, there is considerable variation in the clinical tests; some studies show high sensitivity, whereas others show high specificity.
  
  
  CONCLUSIONS
  Because of heterogeneity and overall poor quality, no firm conclusions about the diagnostic performance of the different tests can be drawn. Better-designed studies exploring the accuracy of diagnostic tests are needed to improve the diagnostic policy.
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Irene
authors.initials: I
authors.lastname: de Graaf
authors.forename: Anneloes
authors.initials: A
authors.lastname: Prak
authors.forename: Sita
authors.initials: S
authors.lastname: Bierma-Zeinstra
authors.forename: Siep
authors.initials: S
authors.lastname: Thomas
authors.forename: Wilco
authors.initials: W
authors.lastname: Peul
authors.forename: Bart
authors.initials: B
authors.lastname: Koes
mesh_terms: D003955:Diagnostic Tests, Routine; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D016239:MEDLINE; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013130:Spinal Stenosis / Q000175:diagnosis*