Send to

Choose Destination
Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-46. doi: 10.1097/BRS.0000000000001476.

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

Author information

*Department of Health and Physical Education, Mount Royal University, Calgary, Canada †Department of Public Health, Zurich University of Applied Sciences, Switzerland ‡Department of Orthopaedic Surgery, Dartmouth University, Hanover, NH §Department of Orthopaedic Surgery, Stanford University, Redwood City, CA ||Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada ¶Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia **Department of Orthopaedics and Traumatology, University of Hong Kong ††Department of Surgery, University of Calgary, Canada ‡‡Department of Orthopaedics and Traumatology, Asklepios Gemeinsam für Gesundheit, Schwedt, Germany §§Canadian Memorial Chiropractic College, Calgary, AB, Canada ||||Department of Physical Therapy, University of Pittsburgh, PA ¶¶Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor ***Department of Orthopaedic Surgery and Traumatology, University Hospital of Lausanne, Switzerland †††Department of Orthopaedics and Traumatology, University of Hong Kong ‡‡‡Spine Center, Schulthess Klinik, Zurich §§§Institute for Evaluative Research in Orthopaedic Surgery, University of Berne, Switzerland ||||||Musculoskeletal Service, Leeds Community Healthcare Trust, United Kingdom ¶¶¶Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada ****Department of Physical Medicine and Rehabilitation, Yeungnam University, Gyeongsan, South Korea ††††Department of Orthopaedic Surgery, Chiba University, Japan ‡‡‡‡Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.





The aim of this study was to obtain an expert consensus on which history factors are most important in the clinical diagnosis of lumbar spinal stenosis (LSS).


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 online 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.


A total of 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 six 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 "seven 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.



[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center