INTRODUCTION: The lumbar extension‐loading test is one of a diagnostic loading tests for patients with lumbar spinal stenosis (LSS). However, the efficacy of this test is still uncertain. The purpose of this study was to analyze the diagnostic value of this test compared with the gait‐loading test in patients with LSS.
METHODS: The subjects were 109 cases (58 males and 51 females) of LSS between the year 2001 and 2010. The lumbar extension‐loading test was to keep lumbar extension posture at standing as long as possible. We examined subjective symptoms and objective findings (motor, sensory and reflex) before and after the lumbar extension‐loading test and the gait‐loading test. The efficacy of the lumbar extension‐loading test for diagnosis of the responsible level was assessed and compared with that of the gait‐loading test.
RESULTS: Changes in subjective symptoms and neurological findings after the lumbar extension‐loading(E‐L) or the gait‐loading(G‐L) test were classified into 4 types; Type A: new symptoms/findings were evoked, Type B: increase of the degree of symptoms and/or findings, Type C: increase of the degree, also new symptoms/findings evoked, and Type D: no changes.
1) Incidence of each type
The lumbar extension‐loading test emphasized symptoms/findings in 105 cases (96%). The incidence of each type in the lumbar extension‐loading test was similar to the gait‐loading test.
2) Efficacy for the diagnosis of the responsible‐level: In 57 cases (52%), the lumbar extension‐loading test and the gait‐loading test evoked new symptoms and/or findings and was helpful to determine the true responsible level.
DISCUSSION: The lumbar extension‐loading test which is performed without gait is useful for understanding the pathology of patients with LSS. The lumbar extension‐loading test can determine the true responsible‐level similarly to the gait‐loading test.