A Study on Diagnostic Validity of Spurling Test Compared to Magnetic Resonance Imaging Findings in Diagnosing Herniated Cervical Intervertebral Disc

경추 추간판 탈출증을 진단함에 있어 경추부 자기공명 영상 소견과 비교한 Spurling test의 진단적 타당성에 대한 연구

  • Moon, Tae-Woong (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Kang, Myung-Jin (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Kong, Duck-Hyun (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Kim, Jun-Su (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Yang, Kee-Young (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Lee, Jae-Hoon (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Eun, Young-Jun (Dept. of Oriental Rehabilitation Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital) ;
  • Kim, Ki-Joo (Dept. of Oriental Internal Medicine, Bu-Chun Ja-Seng Oriental Medicine Hospital)
  • 문태웅 (부천자생한방병원 한방재활의학과) ;
  • 강명진 (부천자생한방병원 한방재활의학과) ;
  • 공덕현 (부천자생한방병원 한방재활의학과) ;
  • 김준수 (부천자생한방병원 한방재활의학과) ;
  • 양기영 (부천자생한방병원 한방재활의학과) ;
  • 이재훈 (부천자생한방병원 한방재활의학과) ;
  • 은영준 (부천자생한방병원 한방재활의학과) ;
  • 김기주 (부천자생한방병원 한방내과)
  • Received : 2009.03.10
  • Accepted : 2009.04.10
  • Published : 2009.04.30
  • 28 0


Abstract

Objectives : Spurling test is one of the most widely used physical tests to diagnose herniated cervical intervertebral disc. The purpose of this study is to analyse diagnostic validity of Spurling test. Methods : This study was carried out on 382 subjects who visited Bu-Chun Ja-Seng oriental hospital with the neck pain or radiating pain from neck to upper extremities from November, 2007 to October, 2008. All subjects underwent both Spurling test and cervical magnetic resonance imaging(MRI). The associations between Spurling test and herniated cervical intervertebral disc were analysed. Results : 1. The sensitivity of Spurling test for herniated cervical intervertebral disc was 64%. 2. The specificity of Spurling test for herniated cervical intervertebral disc was 86%. 3. The positive predictive value of Spurling test for herniated cervical intervertebral disc was 93%. 4. The negative predictive value of Spurling test for herniated cervical intervertebral disc was 44%. Conclusions : This study suggests that Spurling test is not useful in screening for herniated cervical intervertebral disc due to the test's relatively low sensitivity. Thus it is necessary to consult advanced tests such as diagnostic imaging to diagnose herniated cervical intervertebral disc.

Keywords

Spurling test;Magnetic resonance imaging(MRI);Sensitivity;Specificity;Diagnostic validity;Herniated cervical intervertebral disc

References

  1. Cote P, Cassidy JD, Carroll L. The prevalence of neck pain and related disability in Saskatchewan adults. Spine. 1998;23(15):1689-98. https://doi.org/10.1097/00007632-199808010-00015
  2. 上海中醫學院. 傷科學. 香蒲:商務印書館. 1982:321.
  3. 대한정형외과학회. 정형외과학. 서울:최신의학사. 1999:664.
  4. Viikary-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in thediagnosis of root compression in cervical disc disease. Spine. 1989;14(3):253-7. https://doi.org/10.1097/00007632-198903000-00003
  5. Matsubata Y, Kato F, Mimatsu K, Kajino G, Nakamura S, Nitta H. Serial changes on MRI in lumbar disc herniations treated conservatively. Neuroradiology. 1995;37:378-83. https://doi.org/10.1007/BF00588017
  6. 장정훈, 채윤원, 최병옥, 최혜수, 박수현, 서현규, 장수경, 김형희, 김성원, 이정숙, 문상은. 사진으로 보는 척추와 사지의 검진. 서울:군자출판사. 2006:360-1.
  7. Spurling RG, Scoville WB. Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet. 1944;78:350-8.
  8. Macnab I, MacCulloch J. Backache. Baltimore: Williams and Willkins Co. 1990:130-4.
  9. Modic MT, Pavlicek W, Weinstein MA, Boumphrey F, Ngo F, Hardy R, Duchesneau PM. Magnetic resonance imaging of intervertebral disc disease: clinical and pulse sequence considerations. Radiology. 1984;152:103-11. https://doi.org/10.1148/radiology.152.1.6729099
  10. 최원식, 김환정, 이광원, 신현대, 추현, 박태우. 요추 추간판 탈출증의 자기공명영상 소견. 대한정형외과학회지. 1992;27(4):963-9.
  11. American Association of Electrodiagnostic Medicine. Guidelines in electrodiagnostic medicine. Muscle Nerve Suppl. 1999;8:209.
  12. 예방의학과 공중보건 편집위원회. 예방의학. 서울:계축문화사. 1999:392-6.
  13. Masaryk TJ, Ross JS, Modic MT, Boumphrey F, Bohlman J, Wilber G. High-resolution magnetic resonance of sequestered lumbar intervertebral discs. American Journal of Reontgenology. 1988;150:1155-62. https://doi.org/10.2214/ajr.150.5.1155
  14. 한방재활의학과학회. 한방재활의학과학. 서울:군자출판사. 2003:57-8.
  15. 대한정형외과학회. 정형외과학. 서울:최신의학사. 2006:584-5.
  16. Bozzao A, Gallucci M, Masciocchi C, Aprilla I, Barile A, Passariello R. Lumbar disc herniation magnetic resonance imaging assessment of natural history in patients treated without surgery. Radiology. 1992;185:135-41. https://doi.org/10.1148/radiology.185.1.1523297
  17. 김함겸. 경추 추간판 탈출증의 유형별 자기공명영상 소견. 한방기학지. 2000;23(2):21-6.
  18. 박창일, 문재호. 재활의학. 서울:한미의학. 2007:936.
  19. Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec. 1948;102:409-37. https://doi.org/10.1002/ar.1091020403
  20. Haughton VM. MR imaging of the spine. Radiology. 1998;166:297-301.
  21. Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine. 2002;27(2):156-9. https://doi.org/10.1097/00007632-200201150-00007
  22. Malanga GA. The diagnosis and treatment of cervical radiculopathy. Med Sci Sports Exerc. 1997;29:236-45.
  23. 한방재활의학과학회. 한방재활의학과학. 서울:군자출판사. 2003:57-8.
  24. Esses SI. Textbook of spinal disorders. 서울:군자출판사. 2002:193,201-3.
  25. Lee SH, Coleman PE. Hann FJ. Magnetic resonance imaging of degenerative disc disease of the spine. Radiology. 1988;26(5):949-64.
  26. Porterfield JA. Derosa C. Mechanical neck pain(한국어판). 서울:지성출판사. 1998:2-4.
  27. Lauterbur PC. Image formation by induced local interactions examples employing nuclear magnetic resonance. Nature. 1973;242:190. https://doi.org/10.1038/242190a0
  28. Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. EURA MEDICOPHYS. 2007;43:79-89.
  29. Wainner RS, Fritz JM, Irrgang JJ. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62 https://doi.org/10.1097/00007632-200301010-00014
  30. Rubinstein SM, Pool JJM, Van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine. 2007;16:307-19. https://doi.org/10.1007/s00586-006-0225-6