Modified Romberg Sign | Lumbar Stenosis | Neurogenic Claudication

The Modified Romberg Sign assesses balance with eyes closed for 10 seconds, which can be used in the assessment of lumbar spinal stenosis.

De Schepper et al. (2013) performed a systematic review on the diagnostic accuracy of tests used to diagnose lumbar spinal stenosis. They concluded that the diagnosis should be mainly based on patient history taking, while physical examination tests have not been found to be useful. However, a more recent systematic review by Cook et al. (2019) found that a couple of physical tests can actually be useful to confirm the diagnosis. One of them is the modified Romberg test like described by Katz et al. (1995). With a sensitivity of 40% and a specificity of 91%, this test is moderate to confirm, but not exclude lumbar spinal stenosis.

As neurogenic claudication due to lumbar spinal stenosis is related to activity, it makes sense to use functional tests in order to provoke symptoms. To conduct the modified Romberg test, have a patient stand with their feet together and eyes closed for 10 seconds.

The test is considered positive if compensatory movements were required to keep the feet planted. Originally, the Romberg Test is used devised to differentiate between cerebellar and sensory ataxia. If eye closure leads to a significant decrease in stability the Romberg sign is scored positive and is indicative of sensory dysfunction. A negative Romberg sign speaks for cerebellar disease as the cause of ataxia. Cerebellar ataxia is not, or hardly, ameliorated by additional visual feedback. This is true of cerebellar limb ataxia as well.

Other common tests for lumbar spinal stenosis are:

• Clinical prediction rule of Cook
• Two-Stage Treadmill Test
• Kemp’s Test/Quadrant Test

De Schepper, E. I., Overdevest, G. M., Suri, P., Peul, W. C., Oei, E. H., Koes, B. W., … & Luijsterburg, P. A. (2013). Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine, 38(8), E469-E481.

Cook, C. J., Cook, C. E., Reiman, M. P., Joshi, A. B., Richardson, W., & Garcia, A. N. (2020). Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal stenosis. European Spine Journal, 29(1), 93-112.

Katz, J. N., Dalgas, M., Stucki, G., Katz, N. P., Bayley, J., Fossel, A. H., … & Lipson, S. J. (1995). Degenerative lumbar spinal stenosis Diagnostic value of the history and physical examination. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 38(9), 1236-1241.