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Lumbar spinal stenosis history cluster (Cook, 5 items)

For: Lumbar spinal stenosis

Website-only test: not part of the book.

Narrowing of the spaces in the lower spine that carry the nerves, usually from age-related change. Typically causes pain, heaviness or tingling in the buttocks or legs on walking or standing that eases with sitting or bending forward.

Treat with caution (see below)
Sensitivity96%
Specificitynot given
LR+ (positive)not given
LR− (negative)0.19

Sensitivity and LR− are for the rule-out use (none of the five present). The study's LR+ of 4.6 is for four of five present, a different cut-off, so it is given in the note rather than above.

Caution: Case–control study in tertiary care, where the surgeons' diagnosis used the same history items; not externally validated.

These figures have not been confirmed against the full paper (checked against the abstract or a secondary source only).

How it is done

Check five findings from the history and observation: (1) symptoms on both sides; (2) leg pain worse than back pain; (3) pain during walking or standing; (4) pain relieved by sitting; (5) age over 48. Rule-out: if none of the five is present, stenosis is unlikely. Rule-in, as reported: four of the five present made stenosis somewhat more likely (LR+ 4.6, a small shift).

What the studies found

Lumbar spinal stenosis. Cook et al. 2011 analysed 1,448 patients with back pain, with or without leg pain, in tertiary care at a medical centre; the diagnosis was made by one of two experienced orthopaedic surgeons from clinical findings and imaging. With none of the five present: sensitivity 96% (95% CI 94–97%), LR− 0.19 (0.12–0.29). Specificity was not reported; the published figures imply only about 21% at this cut-off, so most people without stenosis also have at least one item. With four of five present: LR+ 4.6 (2.4–8.9). Case–control design in tertiary care, and the surgeons' diagnosis drew on the same history items (incorporation bias), both of which flatter accuracy. Not externally validated.

What the numbers mean

  • Negative result: see the caution above before relying on this result.

The ladder: what a result does to your estimate

If you thoughtAfter a positiveAfter a negative
10%—2%
30%—8%
50%—16%

Calculated from the likelihood ratios above. Read the caution above before relying on these. For any other starting estimate, use the probability calculator.

Work out what a result means for your patient: probability calculator

Other tests in the library for lumbar spinal stenosis

Compare all the tests for lumbar spinal stenosis side by side

Source

Cook C, Brown C, Michael K, Isaacs R, Howes C, Richardson W, Roman M, Hegedus E. The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiother Res Int. 2011;16(3):170–178. Journal article (DOI) · single study

Website-only test: added to the library on 9 October 2026 and not part of Rule It In, Rule It Out. Figures independently checked against the sources cited above; any note above says where only the abstract could be checked. If a newer or better study changes them, this page will be updated.

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This test is in the website library only; it is not one of the tests in Rule It In, Rule It Out. The book covers the tests in its ‘The low back and pelvis’ chapter: how to do each one, what counts as positive, and how to read the result.

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