Execution
- 1Position the patient standing with the feet shoulder-width apart near an examination table.
- 2Ask the patient to flex forward and place both hands on the table.
- 3Inspect and palpate the lumbar interspinous spaces in flexion, focusing on unusually widened gaps or altered spinous position.
- 4Ask the patient to extend from the flexed position by moving the trunk upward and the buttocks toward the table.
- 5Compare interspinous gap width and relative spinous process position between flexion and extension.
Positive outcome
A visible or palpable abnormal change in interspinous spacing or spinous process position during lumbar flexion-extension is positive. The test is intended to detect lumbar instability using a clinical analogue of flexion-extension radiographs. The exact level and direction of the change should be documented.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Ahn & Jhun (2015) | NA | 82.2 | 60.7 | 2.09 | 0.29 |
CommentAhn and Jhun reported reasonable sensitivity but only moderate specificity for radiographic lumbar instability, using flexion-extension radiographs as the reference. This is a single-study test with a high-prevalence clinical sample, so the values should not be generalized too widely. It may be useful as a quick outpatient screen, but imaging remains the reference when instability classification matters.
Moderate Clinical Value