Lumbar spinal stenosis diagnostic support tool (Konno score)

How it is done

Add up the points: age 60–70, +1; over 70, +2; no diabetes, +1; neurogenic claudication (leg symptoms on walking that ease with rest), +3; symptoms worse on standing up, +2; symptoms ease when bending forward, +3; bending forward brings on symptoms, −1; bending backward brings on symptoms, +1; normal ankle–brachial pressure index (a blood-pressure check of leg circulation), +3; reduced Achilles reflex, +1; straight leg raise reproduces the pain, −2. Positive: a total of 7 or more. Under 7: stenosis unlikely.

What the studies found

Lumbar spinal stenosis in patients with leg pain or numbness. Konno et al. 2007 developed the score in 468 Japanese patients; the reference standard was the expert physicians' consensus diagnosis, with X-ray and MRI confirmation; that diagnosis drew on the same history findings (incorporation bias). At 7 or more: sensitivity 92.8%, specificity 72.0%; the Suri 2010 JAMA review gives LR+ 3.3 (95% CI 2.7–4.0) and LR− 0.10 (0.06–0.16). An independent validation (Kato), reported in the same review, found LR+ only 1.6 (1.3–2.0) and LR− 0.13 (0.04–0.41): useful for making stenosis less likely, weak for making it more likely. A very large Japanese study by the same research network (Nikaido 2023, 28,883 patients at 2,177 hospitals, with the doctors' final diagnosis from history, examination and imaging as the reference) found the original tool had sensitivity 88.2% and specificity 83.9% (about LR+ 5.5 and LR− 0.14). It also tested version 2.0, which replaces the ankle–brachial index with feeling for the posterior tibial pulse: sensitivity 87.7%, specificity 78.3%; that study's summary does not restate the scoring or cut-off for version 2.0. Tested in Japanese populations only.

What the numbers mean

• Positive result: a small shift: a positive result nudges the diagnosis up, but does not settle it.
• Negative result: see the caution above before relying on this result.

The ladder: what a result does to your estimate

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

• Lumbar spinal stenosis history cluster (Cook, 5 items)
• No pain when seated (lumbar spinal stenosis)
• Wide-based gait (lumbar spinal stenosis)

Compare all the tests for lumbar spinal stenosis side by side

Source

Konno S, Hayashino Y, Fukuhara S, Kikuchi S, Kaneda K, Seichi A, Chiba K, Satomi K, Nagata K, Kawai S. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J. 2007;16(11):1951–1957. Journal article (DOI) · single study
Also cited: Suri P, Rainville J, Kalichman L, Katz JN. Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA. 2010;304(23):2628–2636. Journal article (DOI)
Also cited: Nikaido T, Sekiguchi M, Yonemoto K, et al. Generalization of a clinical diagnosis support tool for lumbar spinal stenosis: can the ankle brachial pressure index be replaced by palpation of the posterior tibial artery in the lumbar spinal stenosis diagnostic support tool? (DISTO project). J Orthop Sci. 2023;28(3):543–546. Journal article (DOI)

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.