Send to:

Choose Destination
See comment in PubMed Commons below
Spine (Phila Pa 1976). 2016 Feb 1. [Epub ahead of print]

Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.

Author information

  • 1*Mount Royal University, Canada (Chair of Taskforce) †Zurich University of Applied Sciences, Switzerland (Co-Chair) ‡Dartmouth University, USA §Stanford University, USA ¶University of Adelaide, Australia ||University of Hong Kong, Hong Kong **University of Calgary, Canada ††Asklepios Gemeinsam für Gesundheit, Germany ‡‡Canadian Memorial Chiropractic College, Canada §§University of Pittsburgh, USA ¶¶University of Michigan, USA ||||University Hospital of Lausanne, Switzerland ***Queen Mary Hospital, Hong Kong †††Spine Center, Schulthess Klinik, Switzerland ‡‡‡University of Berne, Switzerland §§§Wharfedale General Hospital, United Kingdom ¶¶¶University of Alberta, Canada ||||||Yeungnam University, South Korea ****Chiba University, Japan ††††University of Michigan. ‡‡‡‡University of Alberta, Canada.





Obtain an expert consensus on which history factors are most important in the clinical diagnosis of LSS.


Lumbar spinal stenosis (LSS) is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.


Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An on-line survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.


279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were "leg or buttock pain while walking", "flex forward to relieve symptoms", "feel relief when using a shopping cart or bicycle", "motor or sensory disturbance while walking", "normal and symmetric foot pulses", "lower extremity weakness" and "low back pain". Significant change in certainty ceased after 6 questions at 80% (p < .05).


This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of "7 history items" that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes.



[PubMed - as supplied by publisher]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins
    Loading ...
    Write to the Help Desk