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Summary
Fifty two patients with herniated lumbar disc (HLD) confirmed at surgery without spinal stenosis were reviewed in order to determine the diagnostic value of clinical articular signs (AS), ie the pattern of pain and/or limitation of lumbar movements, as compared to that offered by metrizamide myelography (M) and CT scan. The global sensitivity (true positive cases) of these clinical diagnostic tests was 77% for AS, 85% for CT scan and 81% for myelography. Of the total, 38 true positive cases disclosed agreement in the diagnosis of HLD according to the three diagnostic methods. Agreement between both surgical findings and AS score occurred in 26 of the 38 cases (68%), CT scan images correlated with surgical findings in 24 (63 %) and myelograms in only 16 (42%). When the scores of the three diagnostic methods were matched with the type of surgical findings in the 38 true positive cases, CT scan showed a higher sensitivity for grade II HLD while the elicitation of AS was found to be superior in grade III HLD cases (extruded discs). In conclusion, the clinical assessment of articular signs is a useful, easy and quick method in the diagnosis of herniated lumbar disc. However, the major drawback is that articular signs give no information about the anatomical level of the lesion as both myelography and CT scan can do.