Diagnostic accuracy of the compression overload test versus straight leg Raise test in detecting lumbar disc herniation: an MRI-Validated Cross-Sectional study

Purpose: To determine the diagnostic performance of the Compression Overload Test (COLT) compared with the Straight Leg Raise Test (SLRT) in detecting lumbar intervertebral disc herniation (IVDH), using MRI as the reference standard. A secondary objective was to evaluate the correlation between each test and MRI results. Method: Fifty-three 53 participants (mean age: 37.26 ± 12.16) with MRI-confirmed acute lumbar IVDH were included in the study. COLT and SLRT tests were conducted by the principal investigator, blinded to participant history, clinical findings, and MRI, while the co-investigator collected demographic and clinical data. Diagnostic performance was evaluated by sensitivity, specificity, and receiver operating characteristic (ROC) curve measures. Results: COLT demonstrated a higher diagnostic yield than SLRT, with a sensitivity of 92% and an overall diagnostic accuracy of 90.57%. It demonstrated moderate agreement with MRI findings (κ = 0.399) and a positive correlation (Φ = 0.428), with an area under the curve (AUC) of 0.793. In contrast, SLRT had no agreement (κ = -0.008) and no correlation (Φ = -0.0274) with MRI and a poor AUC (0.473). MRI predominantly identified L4–L5 herniations (47.5%) and disc bulges (54.5%). Vertebral endplate abnormalities, including Schmorl’s nodes and Modic changes, were observed in 20 participants. Conclusion: COLT showed higher diagnostic utility than SLRT and correlated well with MRI results.