Lordosis manoeuvre in the diagnosis of lumbar facet syndrome.
In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation.


OBJECTIVE
The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies


METHODS
A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one.


METHODS
Deformity and instability. using a physical.


OBJECTIVE
To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL).


METHODS
R package software.


RESULTS
The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM.


CONCLUSIONS
A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.
Servicio de Cirugía Ortopédica y Traumatológica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España. Electronic address: maximoalberto.diez@usc.es.
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Díez-Ulloa
Departamento de Neurocirugía, Hospital Clínico Quirúrgico Universitario Dr. Miguel Enríquez Espinoza, La Habana, Cuba.
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Almira Suárez
Servicio de Cirugía Ortopédica y Traumatológica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España.
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Otero Fernández
Servicio de Cirugía Ortopédica y Traumatológica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España.
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Leborans Eiras
Departamento de Neurocirugía, Hospital Universitario La Raza, México, Distrito Federal, México.
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Collado Arce
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis*; D013126:Spinal Nerve Roots; D013577:Syndrome
Bloqueo facetario; Dolor lumbar; Dorsal branch; Facet block; Low back pain; Lumbar facet syndrome; Lumbar root; Medial branch; Ramo dorsal; Ramo medial; Raíz lumbar; Rhizolysis; Rizólisis; Síndrome facetario lumbar