The Straight Leg Raising Test and the Severity of Symptoms in Lumbar Disc Herniation

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Abstract
In a prospective, consecutive study, correlation between the straight leg raising and other pain-related symptoms in lumbar disc herniation was evaluated preoperatively and postoperatively. All patients were interviewed and examined preoperatively and at follow-up investigations 4 and 12 months postoperatively. One-hundred-and-fifty consecutive patients underwent lumbar disc surgery. Mean patient age was 42 years (range, 21-81 years). Eighty-nine patients were men and 61 were women. Two herniations occurred at L2-L3, seven at L3-L4, 61 at L4-L5, and 80 at L5-S1. Pain at rest, at night, and upon coughing was recorded. Consumption of analgesics was classified into three categories: 1) none, 2) intermittent, or 3) regular. Walking capacity was recorded as > 5 km, 1-5 km, 0.5-1 km, or < 0.5 km. The straight leg raising test was graded pos 0 degree-30 degrees, pos 30 degrees-60 degrees, pos > 60 degrees, or negative. At surgery, the herniation was classified as focal protrusion, subligamentous herniation, or perforation. The patient's assessment of outcome was graded into one of four categories. There was an almost linear correlation between a positive straight leg raising test and pain at rest, pain at night, pain upon coughing, and reduction of walking capacity. Regular consumption of analgesics was more common in patients who had a very restricted positive straight leg raising test (30 degrees). A positive straight leg raising test early postoperatively correlated with inferior outcome of the surgical procedure. The straight leg raising test as performed in clinical practice has a strong correlation with various parameters that signify the pain level of the patient. A positive straight leg raising test postoperatively correlates with inferior surgical outcome.

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