This prospective observational study aims to evaluate the sensitivity of the femoral stretch test in patients with unilateral, single-root L2, L3, or L4 nerve root compression and to determine whether test positivity differs according to the affected nerve root. Patients with unilateral radicular symptoms and magnetic resonance imaging-confirmed single-root compression involving the L2, L3, or L4 nerve root who are scheduled to undergo transforaminal epidural steroid injection as part of routine clinical care will be included. The decision to perform transforaminal epidural steroid injection will be made independently of participation in the study. Before the procedure, the femoral stretch test, pain intensity, neuropathic pain characteristics, dermatomal concordance of symptoms, and relevant magnetic resonance imaging findings will be recorded. The femoral stretch test and pain intensity will be reassessed 1 hour after the procedure. The study will primarily evaluate the sensitivity of the femoral stretch test for L2, L3, and L4 nerve root involvement and will also assess changes in test findings following transforaminal epidural steroid injection.
Study Type
OBSERVATIONAL
Enrollment
120
Marmara University Pendik Training and Research Hospital
Istanbul, Pendik, Turkey (Türkiye)
RECRUITINGRoot-Level Sensitivity of the Femoral Stretch Test for L2, L3, and L4 Nerve Root Compression
The sensitivity of the femoral stretch test will be calculated separately in patients with unilateral, Magnetic Resonance Imaging-confirmed single-root L2, L3, and L4 nerve root compression. Root-level sensitivities will be compared to determine whether the diagnostic sensitivity of the test differs according to the affected nerve root.
Time frame: Baseline
Change in Femoral Stretch Test Positivity Following Transforaminal Epidural Steroid Injection
Femoral stretch test results will be recorded as positive or negative immediately before and after transforaminal epidural steroid injection. The proportion of patients with a change from a positive to a negative test following the procedure will be evaluated overall and according to the affected nerve root (L2, L3, and L4).
Time frame: Baseline and 1 hour post-procedure
Change in Pain Intensity Following Transforaminal Epidural Steroid Injection
Pain intensity will be assessed using the Numeric Rating Scale, ranging from 0 (no pain) to 10 (worst imaginable pain), immediately before and after transforaminal epidural steroid injection. The change in Numeric Rating Scale score following the procedure will be evaluated.
Time frame: Baseline and 1 hour post-procedure
Association Between Femoral Stretch Test Positivity and Magnetic Resonance Imaging Nerve Root Compression Severity
The association between pre-procedural femoral stretch test positivity and the severity of nerve root compression on lumbar magnetic resonance imaging will be evaluated in patients with unilateral, single-root L2, L3, or L4 nerve root compression.
Time frame: Baseline
Association Between Femoral Stretch Test Positivity and Neuropathic Pain Characteristics
Neuropathic pain characteristics will be assessed using the 10-item DN4 neuropathic pain questionnaire, a validated screening tool for neuropathic pain. The total score ranges from 0 to 10, with higher scores indicating a greater likelihood of neuropathic pain. The association between the pre-procedural DN4 score and femoral stretch test positivity will be evaluated in patients with unilateral, single-root L2, L3, or L4 nerve root compression.
Time frame: Baseline
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