Table 4 Data extraction for classification systems: Systems classifying by Pathoanatomy
From: Classification of patients with low back-related leg pain: a systematic review
Primary author | Purpose | Method of development | Domain of interest | Specific exclusions | Categories | Criteria used | Training/Personnel needed |
|---|---|---|---|---|---|---|---|
Bernard and Kirkaldy Willis (1987) [41] | Determine pathology causing LBP. | Judgement approach. Orthopaedic surgeon authorship. | LBP. Medical record review of 1293 patients, majority of whom had failed initial treatment by primary care physicians. | None. | Group A:well recognized syndromes 1. Herniated nucleus pulposus 2. Lateral spinal stenosis 3. Central spinal stenosis 4. Spondylolisthesis 5. Segmental instability Group B:less well recognized syndromes 6. Sacroiliac joint 7. Posterior joint 8. Maigne’s syndrome 9. Gluteus maximus 10. Gluteus medius 11. Quadratus lumborum 12. Piriformis 13. Hamstring origin 14. Tensor fascia latae Group C: remaining syndromes 15. Pseudarthrosis 16. Non specific 17. Post fusion stenosis 18. Anklyosing spondylitis 19. Disc space infection 20. Tumour 21. Arachnoiditis 22. Lateral femoral nerve entrapment | Medical records and response to treatment which included: manipulation/stretching; injections; radiofrequency denervation; palpation; joint motion tests, neural tension tests and neurological testing, response to surgery, pain provocation palpation, xray and computed tomography (CT) scans. | None. |
Cassisi et al. (1993) [40] | Explore differences between two groups of chronic LBP patients. | Judgement approach. Neurosurgeon authorship. | Chronic LBP. 151 patients in tertiary care. | Neoplasm, mechanical, toxic-metabolic, inflammatory-infectious, vascular and psycho-physiological conditions. | Myofascial pain. Disc herniation. | Patient history and clinical examination. | None. |
Hahne et al. (2011) [38] | Identify patho-anatomical subgroups with subacute LBP. For use in a randomised controlled trial (RCT): the STOPS trial. | Judgement approach including an expert panel of physiotherapists. Physiotherapy authorship. | LBP +/- leg pain. Subacute pain lasting between 6Â weeks and 6Â months. | Red flags, recent spinal injections, previous spinal surgery, recent regular physiotherapy treatment. | 1: Reducible discogenic pain 2: Non reducible discogenic pain (not responsive to mechanical loading strategies) 3: Disc herniation with associated radiculopathy 4: Facet joint dysfunction 5: Multi-factorial persistent pain | Patient history and clinical examination. | Unclear what specific training is needed for classification. |
Paatelma et al. (2009) [44] | Evaluate the reliability of a patho-anatomical classification system. | Judgement approach. Physiotherapy authorship. | LBP +/- leg pain. 21 patients. | Age > 56, LBP > 3 months. | 1: Discogenic pain 2: Lumbar instability 3: Spinal Stenosis 4: Segmental dysfunction/facet pain 5: SIJ dysfunction/pain | Patient history and clinical examination. | 5 ½ day training sessions to standardise tests. 30 min assessment. |
Petersen et al. (2003) [39] | Develop a classification system with pathoanatomic orientation for use in primary care. | Judgemental approach. Physiotherapist authorship. Slightly modified version of Laslett and van Wijmen (1999) [81] classification system. | Non-specific LBP. | Red flag symptoms, hip disorders, suspected referred pain from viscera. | 1: Disc syndrome (reducible;irreducable and non-mechanical) 2: Adherent nerve root 3: Nerve root entrapment 4: Nerve root compression 5: Spinal stenosis 6: Zygapophysial joint 7: Postural 8: Sacro-iliac joint 9: Myofascial pain 10: Adverse neural tension 11: Abnormal pain 12: Inconclusive | Patient history and clinical examination. | Some training required and experience of the McKenzie assessment. Takes 1Â h to complete. |
Vining et al. 2013 [46] | Create a classification system based on available evidence for use in research and clinical setting | Judgement approach. Based on Petersen et al. (2003) [80] model Chiropractic authorship. | LBP. | None | 1. Screening 2. Nociceptive - Discogenic - SIJ - Zygapophyseal joint -Myofascial 3. Neuropathic - Compressive radiculopathy - Non compressive radiculopathy - Neurogenic claudication - Central pain 4. Functional instability 5. Other diagnoses | Patient history and clinical examination. Questions and physical component of the Leeds Assessment for Neuropathic Symptoms and Signs (LANSS). Arterial brachial index test for neurogenic claudication if indicated | None. |