A study of the diagnostic accuracy and reliability of the Scoliometer and Adam's forward bend test.

STUDY DESIGN: Study of the diagnostic accuracy and interexaminer reliability of scoliosis diagnostic tests. OBJECTIVES: To estimate the sensitivity, specificity, and predictive value of the Scoliometer (National Scoliosis Foundation, Watertown, MA) and Adam's forward bend test in diagnosing scoliosis, and to determine the interexaminer reliability of the Scoliometer and Adam's forward bend test. SUMMARY OF BACKGROUND DATA: Exposure to diagnostic radiation in patients with adolescent idiopathic scoliosis may result in a small but significant increase in cancer rates. The full-spine radiographic examination remains the standard procedure for the assessment of scoliosis. There is a need for a valid and reliable noinvasive test to assess scoliosis. METHODS: Two examiners independently assessed 105 patients presenting to a scoliosis clinic for trunk asymmetry with Adam's forward bend test and axial trunk rotation with the Scoliometer. The Cobb method served as the gold standard. RESULTS: The interexaminer agreement for the Scoliometer is excellent in the thoracic spine and substantial in the lumbar spine. The interexaminer measurement error shows poor precision for thoracic and lumbar Scoliometer measurements. The interexaminer agreement for Adam's forward bend test is substantial in the thoracic spine and poor in the lumbar spine. Adam's forward bend test is more sensitive than the Scoliometer in detecting thoracic curves measuring 20 degrees or more by the Cobb method. Receiver operating characteristic curve analysis suggests that the use of the Scoliometer marginally improves the ability of diagnosing a scoliosis in the thoracic spine. CONCLUSIONS: The Scoliometer and Adam's forward bend tests have adequate interexaminer reliability for the assessment of thoracic curves. The Scoliometer has better interexaminer agreement in the lumbar spine. However, the Scoliometer has a high level of interexaminer measurement error that limits its use as an outcome instrument. Because Adam's forward bend test is more sensitive than the Scoliometer, the authors believe that it remains the best noninvasive clinical test to evaluate scoliosis.

Crossed femoral stretching test. A case report.

STUDY DESIGN: A case is reported of L3-L4 far lateral disc herniation, in which the femoral stretching and crossed femoral stretching tests were positive. OBJECTIVES: To discuss the clinical usefulness and pathophysiologic mechanics of the femoral and crossed femoral nerve stretching tests. SUMMARY OF BACKGROUND DATA: The femoral and crossed femoral stretching tests have received little clinical and research attention. The validity of these two nerve root tension signs to evaluate upper disc herniations remains unknown. METHODS: A 73-year-old woman presented with progressive low back pain and left anterolateral thigh pain of 2 months duration. The diagnosis of far lateral disc herniation at L3-L4 was initially suspected from a positive crossed femoral nerve stretch. An open discectomy was performed without complications. RESULTS: Eight months after surgery, the patient had recovered and the femoral and crossed femoral stretching tests were negative. CONCLUSIONS: It is hypothesized that the crossed femoral stretching test may be a valid maneuver to help in the diagnosis of symptomatic disc herniation above L4.

The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis.

OBJECTIVE: To determine the validity of the neck extension-rotation test as a clinical screening procedure to detect decreased vertebrobasilar blood flow that might be associated with dizziness. DESIGN: Secondary analysis of a clinical screening test. METHODS: Twelve subjects with dizziness reproduced by the extension-rotation test and 30 healthy control subjects had Doppler ultrasonography examination of their vertebral arteries with the neck extended and rotated. Vascular impedance to blood flow was measured and the presence of signs and symptoms of vertebrobasilar ischemia was recorded. RESULTS: Cut-off points for validity estimates were derived through the percentile and Gaussian methods using impedance to blood flow as the standard. The sensitivity of the extension-rotation test for increased impedance to blood flow was 0%, regardless of the selected cut-off point. The specificity rates for the left vertebral artery were 71% and 67% for the percentile and Gaussian methods, respectively. The extension-rotation test was more specific on the right side, with a rate varying from 90% with the percentile method to 86% with the Gaussian technique. The positive predictive value of the test was 0% and its negative predictive value ranged from 63% to 97%. CONCLUSION: We were unable to demonstrate that the extension-rotation test is a valid clinical screening procedure to detect decreased blood flow in the vertebral artery. The value of this test for screening patients at risk of stroke after cervical manipulation is questionable.

L5 vertebral compression fracture: a series of five cases.

OBJECTIVE: The purpose of this paper is to discuss five cases of L5 vertebral compression fracture (VCF), illustrating the epidemiology, clinical presentation and radiographic appearance of the fracture at this uncommon site. Additionally, an empirical approach to conservative management of L5 VCFs is also discussed. DESIGN: A series of five cases. SETTING: Private chiropractic clinic. CONCLUSIONS: Compression fractures at the L5 level are rare; however, this problem should be considered in postmenopausal women who suffer from low back pain and in young men with a history of trauma. Conservative treatment options, including both passive therapy and exercise, can be beneficial in the management of this condition.

Nocturnal enuresis: treatment implications for the chiropractor.

OBJECTIVE: A comprehensive review of the literature concerning the etiology, diagnosis, and the natural history of primary nocturnal enuresis is presented. Contemporary treatment options are discussed in light of the documented annual remission rate of this disorder. DATA SOURCE: Articles reviewed were obtained by conducting a computer-aided search of papers indexed in Medline and the Index to Chiropractic Literature from 1989 to 1993. In addition, the Chiropractic Research Abstracts Collection and bibliographies from pertinent articles were manually searched. DATA SYNTHESIS: Primary nocturnal enuresis affects some 200,000 children and their families throughout Canada. Twenty percent of children wet the bed at age 5, 10% at age 10, and only about 1% at age 15. The documented natural history of the disorder reveals that for those affected, 10% to 20% exhibit spontaneous resolution per year. Contemporary treatment options center on three factors that play primary roles in the etiology of this condition: functional bladder capacity, patient conditioning and the circadian rhythm of nocturnal ADH secretion. CONCLUSIONS: The success of each therapeutic option must, in part, be attributed to the natural history of enuresis, as well as any educational or placebo aspects of treatment. Conditioning therapy utilizing the urine pad alarm may be the most reasonable initial mode of intervention. Spinal manipulative therapy has been shown to possess an efficacy comparable to the natural history.