Why Spinal Sources Get Missed and Which Findings Predict Them

Clinicians surveyed gave reasons for missing these patients: imaging of the joint, misleading pain location, the referring physician's diagnosis, routine, bias, patients convinced the problem is in the limb, cursory spinal checks and, most often, lack of time. Georg shows how to adapt lumbar screening, for example extension with one foot raised, in sitting or with one leg off the bed, so the spine moves but the hip does not. Because most knee patients in the study did have a knee problem, a secondary analysis of 319 patients looked for predictors. Paresthesia doubled the probability of a spinal source, no extremity movement loss raised it 2.2 times, symptoms worse with sitting, bending, turning or being still 2.5 times, spinal movement loss 2.6 times, and symptoms affected by posture change 4 times. Two or more predictors gave the best balance of sensitivity and specificity, so they signal that a more thorough spinal assessment is worth the time. Georg's conclusion is to recheck the spine in isolated extremity pain, using these findings to decide when and how far.