Signs and Evidence

Making clinical sense of scientific data


Beware of the limitations of this tool

Disc herniation

Calculated pretest probability: 49.3 %
Relevant inclusion criteria: All back pain 

Clinical signs

1Calf wasting
2Slump test
3Weak ankle dorsiflexion
4Straight Leg Raising test
5Ankle reflex abnormal
6Leg sensation abnormal

To further investigations

Sources used:

1.Majlesi J et al. The Sensitivity and Specificity of the Slump and the Straight Leg Raising Tests in Patients With Lumbar Disc Herniation. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 14(2):87-91 · May 2008
2.Ekedahl H et al. Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms. Archives of Physical Medicine and Rehabilitation Volume 99, Issue 4, April 2018, Pages 726-735
3.Omar S et al. Accuracy of straight leg raise test in patients with lumbar disc Herniation keeping magnetic resonance imaging as a reference Standard. Pak Armed Forces Med J 2016; 66(1):53-56
4.David S at al. Acute Lumbar Disk Pain: Navigating Evaluation and Treatment Choices. Am Fam Physician. 2008 Oct 1;78(7):835-842
5.Cecin AH Cecin's Sign: improving the diagnosis of radicular compression by herniated lumbar disks. Rev. Bras. Reumatol. vol.50 no.1 São Paulo Jan./Feb. 2010
6.Deville WL et al. The test of Lasègue: systematic review of the accuracy in diagnosing herniated discs. Spine (Phila Pa 1976). 2000 May 1;25(9):1140-7
7.Chawalparit O et al. The limited protocol MRI in diagnosis of lumbar disc herniation. J Med Assoc Thai. 2006 Feb;89(2):182-9
8.Rijn RM et al. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. European Spine Journal February 2012, Volume 21, Issue 2, pp 228–239
9.Brinjikji W et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015 Dec;36(12):2394-9