Dr. Lazar (Laza) K. Lazarević (1851-1891)

The founder of Serbian neurology and the author who first described and published the straight leg raising test

Sanja Drača

SerbianSerbian

World neuroscientists about the Lazarević‘s sign

Most of the articles and textbooks give priority to Lasègue for discovery of the straight-leg-raise test. However, there are numerous authors who admit that this test/sign was never put into writing by Lasègue and give credits for its discovery to Serbian physician Lazar K. Lazarević.

We cite some of these statements.

Jane Orient in the book “Sapira’s Art and Science of Bedside Diagnosis” (1): “The Kernig-Lasègue sign was first described in 1880 by a Yugoslav physician Lazarevic (Clain, 1973). He has never received credit for it. His sign is known by two other names to two different groups of specialists who use it for different purposes. Having encouraged the students to describe something original in the hope of eponymous immortality, it must now be recalled how many times the original innovator’s name is lost to posterity. As Shaw noted, virtue is its own punishment”.

Joseph V. McDonald and William C. Welch in the book “Operative spine surgery” (2): “Straight leg raise is usually called Lasègue’s sign. Lasègue did not describe the sign. His pupil, J. Frost, did describe and illustrate it as well as the relief of sciatic pain with flexion of knee while the hip is flexed in a thesis published in Paris in 1881. One year earlier, the straight leg raise test was clearly described by Lazar Lazarevic. Unfortunately, his paper was in Serbian, his native tongue. Even though he republished his findings 4 years later in German, he still has not won an eponym crown. He did show that the straight leg raise stretched the sciatic nerve and flexing the knee reduced it”.

Hans J.G.H. Oosterhuis in the book “Neurological Eponyms” (3): “Independent from Forst, Lasègue, and de Beurmann, the test of the stretched leg was described in 1884 by Lazarevic, a Serbian physician in Belgrade, who also emphasized that the leg should be flexed in the knee as the control test. He explained the pain as produced by stretching of the nerve. Lazarevic claimed that he had described this test as early as 1880 in the Serbian Medical Journal, thus preceding the description of Forst”.

John MS Pearce: “J.J. Forst’s doctoral thesis of 1881 described the sign that his teacher Lasègue had observed but never published. There is, however, a description by a Serbian physician, Laza Lazarevic, in 1880 of «ischias postica contunnii» with restricted straight leg raising” (4, 5).

Jennifer Solomon, Scott Nadler and Joel Press in the book “Musculoskeletal Physical Examination: An Evidence-based Approach” (6): “Lazarevic described this test in 1880, one year earlier than Frost, after he observed 6 patients to have increased pain during stretching of the sciatic nerve. Lazarevic described a 3-step approach to the test… All three maneuvers were noted to reproduce discomfort in the sciatic nerve distribution”.

Robert H. Wilkins and Irwin A. Brody (7): “However, Laza Lazarević, a Yugoslavian physician writing in the Archivum serbicum pro universa scientia et arte medica recipienda in 1880, was actually the first to describe the straight-leg-raising test in sciatica and to identify the stretching of the sciatic nerve as the cause of the pain”.

Peter P. Urban (8): “Historically, it is very important that Lasègue did not describe this sign. The sign was first described, and correctly interpreted by Lazarević”.

Steven McGee (9): “A positive straight-leg-raising test is sometimes called Lasègue’s sign, after the French clinician Charles Laseque (1816 to 1883), although Lasègue never published a description of the sign. His student Forst described a maneuver in his 1881 doctoral thesis, crediting Lasègue. An earlier description of the sign was published by Yugoslavian physician Lazarevic in 1880”.

Allan Clain, writing about Lasègue’s sign in the book “Hamilton Bailey’s Demonstration of Physical Signs in Clinical Surgery” (10): “Laza K. Lazarevic, a Jugoslav physician, first described this sign in 1880”.

Robert Wartenberg (11, 12): “The best known of all nerve stretching tests is the straight-leg raising test, the so-called Lasègue. Historically, this eponym is not correct. It is true that Lasègue introduced this test but he never described it. This was done by his pupil Forst in 1881. Earlier, in 1880, the test was described by the Serbian clinician Lazarević of Belgrade”.

Kalayan B. Bhattacharyya in the book “Eminent neuroscientists. Their Lives and Works”: “Interestingly, Lasègue did not write about this sign anywhere, not even in his reference volume, “Considerations on Sciatica” published in 1864, which dealt with his analysis of the then prevailing theories on sciatica and his own clinical observations. Oscar Sugar wrote in the article “Charles Lasègue and His Considerations on Sciatica” published in the Journal of the Medical association in 1985, that it was his pupil, JJ Forst, who in his thesis in 1881, brought the phenomenon to light and ascribed it to his teacher. However, medical historians attribute the sign to Laza K Lazarevic a physician from Belgrade, who described it one year ago” (13, 14). __________________________________________________

  1. Orient JM. Sapira’s Art and Science of Bedside Diagnosis. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2012:547.
  2. McDonald JV and Welch WC. Patient history and neurological examination. In: Welch WC, Jacobs GB, Jackson RP, editors. Operative spine surgery. Simon & Schuster Adult Publishing Group; 1999:23-24.
  3. Oosterhuis HJGH. The test of Lasègue. In: Koehler HPJ, Bruyn GW and Pearce JMS, editors. Neurological Eponyms. New York: Oxford University Press; 2000:149-151.
  4. Pearce JMS. Lasègue sign. Lancet 1989; 1 (8635): 436.
  5. Pearce JMS. J.-J. Forst and Lasègue sign. Journal of Neurology, Neurosurgery and Psychiatry 1988; 51: 1157.
  6. Solomon J, Nadler SF, Press J. Physical examination of the lumbar spine. In: Malanga GA and Nadler SF, editors. Musculoskeletal Physical Examination: An Evidence-based Approach. Philadelphia: Elsevier Mosby; 2006:208.
  7. Wilkins RH, Brody IA. Lasègue Sign. Arch Neurol 1969; 21: 219-220.
  8. Urban PP. Klinisch-neurologische Untersuchungstechniken. Georg Thieme Verlag, 2012; 34.
  9. McGee SR. Evidence-Based Physical Diagnosis. 3rd ed. Philadelphia: Elsevier Health Sciences 2012:606.
  10. Clain A. Hamilton Bailey’s Demonstration of Physical Signs in Clinical Surgery. 15th ed. Baltimore: Williams & Wilkins; 1973:212.
  11. Wartenberg R. On neurologic terminology, eponym and the Lasègue’s sign. Neurology 1956; 6: 853-858.
  12. Wartenberg R.: Lasegue Sign and Kerning Sign. Arch Neur Psych 1951; 66 (1):58-60.
  13. Bhattacharyya KB. Ernst-Charles Lasègue. In: Eminent Neuroscientists, Their Lives and Works. Kolkata: Academic Publishers; 2011:139-140.
  14. Sugar O. Charles Lasague and His „Consideration on Sciatica”. JAMA 1985; 253: 1767-1768.