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      Relationship Between Magnetic Resonance Imaging Findings and Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis: a Case-control Study

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          Abstract

          Introduction:

          Despite the availability of many imaging and clinical criteria for diagnosis of lumbar spinal stenosis (LSS), its correct diagnosis is a challenge for clinicians and radiologists.

          Aim:

          The aim of this study was to examine the relationship between magnetic resonance imaging (MRI) findings and clinical symptoms in symptomatic and asymptomatic patients with suspected LSS in MRI.

          Methods:

          This study is a case-control study. Two groups of 100 symptomatic and asymptomatic individuals (aged 20 to 84 years) with suspected lumbar spinal canal stenosis who referred to the imaging unit for lumbosacral MRI were included. The clinical symptoms and radiological parameters in MRI for all patients were recorded and relationship between them were evaluated.

          Results:

          Among the quantitative imaging findings, only the anterior-posterior diameter of the canal at the level of the intervertebral disc, the central spinal canal cross-section area and lateral recesses cross-sectional area were valuable. Coefficient of stenosis was calculated for the case and control groups which had statistically significant difference (p<0.001). The difference between qualitative findings such as disc protrusion, extrusion, sequestration and Cauda Equine serpain or redundant was significant between the two groups.

          Conclusion:

          According to the results, among the quantitative criteria of MRI imaging findings, central spinal canal cross-section (less than 77.5 mm2 for central stenosis) and lateral recesses cross-section (less than 22.5 mm2 for lateral stenosis) had the highest sensitivity and specificity for LSS diagnosis in symptomatic and asymptomatic patients with suspected LSS. Strongest observed correlation was between neurogenic claudication and LSS diagnostic radiological markers.

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          Most cited references22

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          Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review

          Background Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radilogical criteria are used to establish inclusion criteria in clincical studies evaluating different treatments in patients with lumbar spinal stenosis. Methods A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities. Results 25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm2) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies. Conclusions There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies.
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            Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.

            Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed.
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              Lumbar spinal stenosis: syndrome, diagnostics and treatment.

              Lumbar spinal stenosis (LSS) comprises narrowing of the spinal canal with subsequent neural compression, and is frequently associated with symptoms of neurogenic claudication. To establish a diagnosis of LSS, clinical history, physical examination results and radiological changes all need to be considered. Patients who exhibit mild to moderate symptoms of LSS should undergo multimodal conservative treatment, such as patient education, pain medication, delordosing physiotherapy and epidural injections. In patients with severe symptoms, surgery is indicated if conservative treatment proves ineffective after 3-6 months. Clinically relevant motor deficits or symptoms of cauda equina syndrome remain absolute indications for surgery. The first randomized, prospective studies have provided class I-II evidence that supports a more rapid and profound decline of LSS symptoms after decompressive surgery than with conservative therapy. In the absence of a valid paraclinical diagnostic marker, however, more evidence-based data are needed to identify those patients for whom the benefit of surgery would outweigh the risk of developing complications. In this Review, we briefly survey the underlying pathophysiology and clinical appearance of LSS, and explore the available diagnostic and therapeutic options, with particular emphasis on neuroradiological findings and outcome predictors.
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                Author and article information

                Journal
                Acta Inform Med
                Acta Inform Med
                Acta Informatica Medica
                Academy of Medical sciences (Bosnia and Herzegovina )
                0353-8109
                1986-5988
                December 2019
                : 27
                : 4
                : 229-233
                Affiliations
                [1 ]Department of Radiology, Faculty of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
                [2 ]Department of Neurosurgery, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
                [3 ]Department of Rheumatology, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
                [4 ]Department of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
                Author notes
                Corresponding author: Dr. Misagh Shafizad; Assistant Professor; Department of Neurosurgery, Imam Khomeini Hospital, Amir Mazandarani Street, Sari, Mazandaran, Iran. Tell: +981133361700. shafizad@ 123456gmail.com . ORCID ID: https://orcid.org/0000-0001-6902-0622
                Article
                AIM-27-229
                10.5455/aim.2019.27.229-233
                7004287
                3597032e-fe6d-4916-bbc3-82da90da3faa
                © 2019 Hadi Majidi, Misagh Shafizad, Fatemeh Niksolat, Mani Mahmudi, Saeed Ehteshami, Motahare Poorali, Zahra Mardannshahi

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 October 2019
                : 06 December 2019
                Categories
                Original Paper

                Bioinformatics & Computational biology
                magnetic resonance imaging,spinal stenosis,signs and symptoms,lumbar vertebrae

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