Overview
Clinical Meaning
Systematic spinal examination combines provocative maneuvers with neurological testing to differentiate radiculopathy, myelopathy, and mechanical back pain.
CNPLE
Systematic spinal examination combines provocative maneuvers with neurological testing to differentiate radiculopathy, myelopathy, and mechanical back pain. Key examination techniques: (1) Straight Leg Raise (SLR/Lasègue test): patient supine, hip flexed with knee extended. Positive: reproduction of radicular pain (shooting pain below knee in dermatomal distribution) at 30-70° of hip flexion. Mechanism: stretches the L4-S1 nerve roots, reproducing symptoms if a herniated disc is compressing these roots. Sensitivity 91% for L4-S1 disc herniation; specificity only 26%. Crossed SLR (raising the contralateral leg reproduces symptoms in the affected leg) has low sensitivity (29%) but HIGH specificity (88%) — strongly suggests disc herniation. (2) Spurling test: for cervical radiculopathy. Patient extends and laterally flexes the cervical spine toward the affected side while the examiner applies axial compression to the head. Positive: reproduction of radicular arm pain. Mechanism: axial loading narrows the neural foramen, compressing an already irritated nerve root. Sensitivity 50%, specificity 86%. (3) Schober test: measures lumbar flexion range of motion. Mark the lumbosacral junction (S1) and 10 cm above. Patient bends forward maximally. Normal: distance increases to ≥15 cm (≥5 cm...
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