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. 2021 Nov 19;18(22):12151.
doi: 10.3390/ijerph182212151.

Validity of a Screening Tool for Patients with a Sub-Threshold Level of Lumbar Instability: A Cross-Sectional Study

Arisa Leungbootnak  1 , Rungthip Puntumetakul  1 , Jaturat Kanpittaya  2 , Thiwaphon Chatprem  1 , Rose Boucaut  3
Affiliations

Validity of a Screening Tool for Patients with a Sub-Threshold Level of Lumbar Instability: A Cross-Sectional Study

Arisa Leungbootnak et al. Int J Environ Res Public Health. .

Abstract

Lumbar instability (LI) comprises one subgroup of those with chronic low back pain (CLBP); it indicates the impairment of at least one of the spinal stabilizing systems, and radiographic criteria of translation and rotation are used for its diagnosis. Previous studies have developed and tested a screening tool for LI where patients with sub-threshold lumbar instability (STLI) were detected in the initial stage of lumbar pathology using radiographs as a gold standard for diagnosis. The radiographic measurement in STLI lies between the range of translation and rotation of the LI and asymptomatic lumbar motion. However, there are no studies indicating the validity and cut-off points of the screening tool for STLI. The current study aimed to determine the validity of an LI screening tool to support the diagnostic process in patients with STLI. This study design was cross-sectional in nature. A total of 135 participants with CLBP, aged between 20 and 60 years, who had undergone flexion and extension radiographs, answered a screening tool with 14 questions. The cut-off score for identifying STLI using the screening tool was at least 6/14 positive responses to the LI questions. The findings suggested that the LI screening tool we tested is effective for the detection of STLI. The tool can be used in outpatient settings.

Keywords: X-ray; lumbar instability; lumbar rotation; lumbar translation; non-radiological lumbar instability; radiography; screening tool; sensitivity; specificity; sub-threshold lumbar instability.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sagittal rotation: a baseline is drawn passing the anterior and posterior endplate of the upper and lower vertebrae where the difference between the flexion and extension radiograph is measured and calculated.
Figure 2
Figure 2
Sagittal translation: a horizontal line is drawn passing the superior endplate of the lower vertebra. Two vertical lines are drawn passing the posterior edge of the upper vertebra and lower vertebra. The distance between the two vertical lines is considered during flexion and extension, and the difference between the two distances from flexion and extension is used in the formula to calculate the segmental translation.
Figure 3
Figure 3
Comparison of the percentage of positive answers to the lumbar instability screening tool questions in chronic low back pain patients with and without the sub-threshold level of lumbar instability.
See this image and copyright information in PMC

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